With the creation of a social distancing policy due to coronavirus disease 2019 (COVID-19), home visit workers are under mental stress as they are treated as the source of infection for COVID-19. Since door-to-door rental equipment examiners and gas inspectors must perform their duties even in the COVID-19 situation, they are being discriminated against so severely. The purpose of study was to examine the mediating role of perceived stress on the relationship between risk perception and fear. Data was collected data through labor unions among 275 home visiting workers who examine rental home appliance equipment or inspecting gas. On-line survey was conducted to assess COVID-19 risk perception, fear, perceived stress, and demographic characteristics. The data was analyzed using PROCESS Macro (Model 4). The results of the study showed that stress plays an important role in increasing COVID-19 fears when COVID-19 risk perception increases. Meanwhile, it was found that COVID-19 fear decreased when the level of perceived stress decreased. To reduce the impact of COVID-19 risk perception on COVID-19 fears, appropriate educational programs to reduce stress should be developed for home visit workers. Policymakers need to develop online or mobile Infectious disease education programs for COVID-19 risk at work and establish policies to apply legal education.

OBJECTIVE: Self-compassion is a healthy way of responding to challenges that may help long-term care professional caregivers (ie, nursing assistants and personal care aides) cope with stress, but its use may vary in important ways. This study explored the relationships between self-compassion and caregiver demographic characteristics, anxiety and depressive symptoms, and job satisfaction in a large racially/ethnically diverse sample of professional caregivers.
METHODS: Cross-sectional self-report questionnaire.
METHODS: A total of 391 professional caregivers, including nursing assistants and personal care aides from 10 nursing homes and 3 assisted living communities in New York, California, and North Carolina.
METHODS: Professional caregivers were invited to complete an online questionnaire regarding stress and coping. Self-compassion was measured using the Self-Compassion for Youth Scale; anxiety and depressive symptoms were assessed using standardized screeners; and job satisfaction was assessed via an item used in a national survey. Self-compassion scores were represented by total scores and individual subscale scores. Analysis of variance was used to examine differences in self-compassion scores based on demographic characteristics, and correlation coefficients were used to explore relationships between self-compassion and mental health symptoms and job satisfaction.
RESULTS: Significant differences were found in self-compassion based on age, race/ethnicity, place of birth, and education. In general, older caregivers, caregivers with higher education, and caregivers born outside the United States had the highest self-compassion, whereas White caregivers had the lowest self-compassion. Self-compassion was negatively associated with anxiety and depressive symptoms and positively associated with job satisfaction.
CONCLUSIONS: Professional caregivers\' use of self-compassion to cope with challenges may depend on characteristics and life experiences influenced by their sociocultural background. Given the link between self-compassion and lower mental health symptoms and higher job satisfaction, it may be helpful to design and implement interventions with these differences in mind.

UNASSIGNED: Home health aides and attendants (HHAs) provide essential care to older adults and those with chronic conditions in the home. However, some HHAs struggle with poor mood and stress, which may have been exacerbated by the COVID-19 pandemic.
UNASSIGNED: To elicit HHAs\' perspectives toward mental health and well-being, including how their job influences both and how to better support the workforce in the future.
UNASSIGNED: For this qualitative study, focus groups and interviews with HHAs were facilitated in English and Spanish from August 17, 2022, to February 9, 2023, in partnership with the 1199SEIU Training and Employment Fund, a benefit fund of the 1199SEIU United Healthcare Workers East and the largest health care union in the US. Included were HHAs at risk for poor mental health and well-being, which were defined as having at least mild or more symptoms on either the 8-item Personal Health Questionnaire depression scale, the 4-item Cohen Perceived Stress Scale, or the University of California, Los Angeles Loneliness Scale.
UNASSIGNED: Mental health and well-being of HHAs.
UNASSIGNED: Focus groups and interviews were audio recorded, professionally transcribed, and translated. A thematic analysis was performed that was informed by Pender\'s Health Promotion Model and the National Institute for Occupational Safety and Health\'s Total Worker Health model.
UNASSIGNED: A total of 28 HHAs from 14 different agencies participated (mean [SD] age, 54.3 [10.8] years; 26 female [93%]). Seventeen participants (61%) spoke Spanish at home. Five key themes emerged: (1) HHAs\' attitudes toward mental health and well-being were influenced by a variety of personal and cultural factors; (2) HHAs\' relationships with their patients impacted their mood in both positive and negative ways; (3) structural and organizational aspects of the job, alongside the COVID-19 pandemic, impacted HHAs\' mood and stress levels; (4) HHAs used a variety of strategies to cope with their emotions; and (5) HHAs were eager for interventions that can improve their mood, particularly those that bring them closer to their colleagues.
UNASSIGNED: These findings suggest that HHAs\' mental health and well-being may be influenced by both personal and occupational factors. Interventions and policies to better support their emotional well-being on the job are warranted.

Directly-Funded (DF) home care allows users to organize and purchase their own care services and is expanding globally. Little is known about the career pathways of home care workers. Our study asks, what experiences and factors do home care workers consider when choosing a work setting? And, specifically, what influences their decisions to work directly for their clients? Framed with Cranford\'s (2020) flexibility-security matrix for analyzing home care dynamics, we remotely interviewed 20 home care workers in two Canadian provinces. Three team members conducted axial coding and thematic analysis using Dedoose software. We identified personal and material factors at the intimate and labor market level that workers weigh when choosing whether to work for an agency or directly for a client. At the intimate level, workers value the flexibility, autonomy, and respect facilitated in care relations when working directly for a client. At the labor market level, agencies provide better job security and the benefit of supervisory support but lower wages. Additionally, as care work often serves as a stepping stone for immigration and citizenship agency positions are considered a more \"legitimate\" option than working directly for a client. Our study shows that workers directly employed by their clients enjoy more flexibility but lack security, whereas agency employed workers risk immediate reductions in working conditions in exchange for limited improvements in safety and supervision and, like other frontline care work, DF home care represents a key career pathway for immigrants with previous experience in health and social care settings.

This process evaluation was conducted in parallel to the randomised controlled feasibility trial of NIDUS-Professional, a manualised remote dementia training intervention for homecare workers (HCWs), delivered alongside an individualised intervention for clients living with dementia and their family carers (NIDUS-Family). The process evaluation reports on: (i) intervention reach, dose and fidelity; (ii) contexts influencing agency engagement and (iii) alignment of findings with theoretical assumptions about how the intervention might produce change.
We report proportions of eligible HCWs receiving any intervention (reach), number of sessions attended (dose; attending ≥4/6 main sessions was predefined as adhering), intervention fidelity and adherence of clients and carers to NIDUS-Family (attending all 6-8 planned sessions). We interviewed HCWs, managers, family carers and facilitators. We integrated and thematically analysed, at the homecare agency level, qualitative interview and intervention recording data.
32/141 (23%) of eligible HCWs and 7/42 (17%) of family carers received any intervention; most who did adhered to the intervention (89% and 71%). Intervention fidelity was high. We analysed interviews with 20/44 HCWs, 3/4 managers and 3/7 family carers, as well as intervention recordings involving 32/44 HCWs. All agencies reported structural challenges in supporting intervention delivery. Agencies with greater management buy-in had higher dose and reach. HCWs valued NIDUS-Professional for enabling group reflection and peer support, providing practical, actionable care strategies and increasing their confidence as practitioners.
NIDUS-Professional was valued by HCWs. Agency management, culture and priorities were key barriers to implementation; we discuss how to address these in a future trial.

As long-term care increasingly moves from facilities to the community, paid caregivers (e.g., home health aides, other home care workers) will play an increasingly important role in the care of people with dementia. This study explores the paid caregiver role in home-based dementia care and how that role changes over time.
We conducted individual, longitudinal interviews with the paid caregiver, family caregiver, and geriatrician of 9 people with moderate-to-severe dementia in the community; the 29 total participants were interviewed on average 3 times over 6 months, for a total of 75 interviews. Interviews were recorded, transcribed, and analyzed with structured case summaries and framework analysis.
Paid caregivers took on distinct roles in the care of each client with dementia. Despite changes in care needs over the study period, roles remained consistent. Paid caregivers, family caregivers, and geriatricians described the central role of families in driving the paid caregiver role. Paid and family caregivers collaborated in the day-to-day care of people with dementia; paid caregivers described their emotional relationships with those they cared for.
Rather than simply providing functional support, paid caregivers provide nuanced care tailored to the needs and preferences of not only each person with dementia (i.e., person-centered care), but also their family caregivers (i.e., family-centered care). Deliberate cultivation of person-centered and family-centered home care may help maximize the positive impact of paid caregivers on people with dementia and their families.

Many older adults with complex care needs live at home due to ageing-in-place policies. This study explored homecare workers\' experiences and suggestions for improvements of care. Twelve semi-structured interviews were analyzed thematically, and revealed pride, capability, and satisfaction in their work, yet they feel undervalued and lack support. They advocate for integrated care models, recognition of their competence, flexible work approaches, and committed leadership. This would enhance patient care and address their own working conditions, addressing concerns from being relegated to the bottom of the hierarchy. They emphasize the need for comprehensive approaches, spanning from housekeeping to end-of-life palliative care.

Heart failure (HF) affects six million people in the U.S., is associated with high morbidity, mortality, and healthcare utilization.(1, 2) Despite a decade of innovation, the majority of interventions aimed at reducing hospitalization and readmissions in HF have not been successful.(3-7) One reason may be that most have overlooked the role of home health aides and attendants (HHAs), who are often highly involved in HF care.(8-13) Despite their contributions, studies have found that HHAs lack specific HF training and have difficulty reaching their nursing supervisors when they need urgent help with their patients. Here we describe the protocol for a pilot randomized control trial (pRCT) assessing a novel stakeholder-engaged intervention that provides HHAs with a) HF training (enhanced usual care arm) and b) HF training plus a mobile health application that allows them to chat with a nurse in real-time (intervention arm). In collaboration with the VNS Health of New York, NY, we will conduct a single-site parallel arm pRCT with 104 participants (HHAs) to evaluate the feasibility, acceptability, and effectiveness (primary outcomes: HF knowledge; HF caregiving self-efficacy) of the intervention among HHAs caring for HF patients. We hypothesize that educating and better integrating HHAs into the care team can improve their ability to provide support for patients and outcomes for HF patients as well (exploratory outcomes include hospitalization, emergency department visits, and readmission). This study offers a novel and potentially scalable way to leverage the HHA workforce and improve the outcomes of the patients for whom they care. Clinical trial.gov registration: NCT04239911.

BACKGROUND: Prolonged standing at work may contribute to increased risk of musculoskeletal pain in home care workers. Patients\' activities of daily living (ADL) score may be a proxy for home care workers\' standing time at work. The objective of the present study was to investigate the association between patients\' ADL self-care score, and workers standing time.
METHODS: This cross-sectional study measured time spent standing, sitting and in physical activity for seven days using thigh-worn accelerometers, among 14 home care workers. Patients\' ADL self-care scores are routinely adjusted by home care nurses, and time intervals of home care visits are stored in home care services electronic patient journal. We collected ADL self-care scores and start and end time points of visits, and categorized ADL self-care scores as low (ADL ≤ 2.0), medium (ADL > 2.0 to 3.0) or high (ADL > 3.0). Physical behavior data were transformed to isometric log-ratios and a mixed-effect model was used to investigate differences in physical behavior between the three ADL self-care score categories.
RESULTS: We analyzed 931 patient visits and found that high ADL self-care scores were associated with longer standing times relative to sitting and physical activity, compared to low ADL score (0.457, p = 0.001). However, no significant differences in time spent standing were found between high and medium ADL patient visits (0.259, p = 0.260), nor medium and low (0.204, p = 0.288). High ADL score patients made up 33.4% of the total care time, despite only making up 7.8% of the number of patients.
CONCLUSIONS: Our findings suggest that caring for patients with high ADL self-care score requires workers to stand for longer durations and that this group of patients constitute a significant proportion of home care workers\' total work time. The findings of this study can inform interventions to improve musculoskeletal health among home care workers by appropriate planning of patient visits.

Medicaid spends nearly 100 billion dollars annually on home and community-based care for the disabled. Much of this care is provided by personal care aides, few of whom have received training related to the services they provide. We conducted a randomized controlled trial to estimate their demand for training. We find that 13 percent of these caregivers complete training without an incentive. Paying the caregivers four times their hourly wage increases training completion by roughly nine percentage points. Additional experimental variation suggests that among individuals confirmed to be aware of the training, the financial incentive increases completion from 35 to 58 percent. Demand curves based on these results suggest that while many caregivers value the opportunity to train, policies aimed at universal take up require large financial incentives.