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Home Care Workers and Dementia Care: Research Insights

By Kezia Scales, PhD | September 18, 2017

This summer, more than 6,000 experts representing 76 countries convened in San Francisco for the largest-ever scientific conference on aging, the 21st IAGG World Congress of Gerontology & Geriatrics. The conference theme—Global Aging and Health: Bridging Science, Policy, and Practice—brought together researchers, practitioners, educators, and students from across disciplines to share knowledge about improving the quality of life for older adults worldwide.

Among the conference attendees was Kezia Scales, Ph.D., Director of Policy Research at PHI, who presented a symposium on home care for persons with dementia that drew from a recently-completed study at the University of Nottingham in England. She was joined by two other researchers from the study: Dr. Kristian Pollock from the University of Nottingham and Dr. Cheryl Travers from Loughborough University.

The aim of the study was to describe high-quality home care for clients with dementia, with a view toward informing both policy and practice. In the study, two researchers immersed themselves as home care workers for nearly a year (a method known as “participant observation”) to gather data on three main research questions:

1.      What do home care workers do?

2.      What does it feel like to give—and to receive—home care?

3.      What key factors appear to influence home care quality?

Their detailed “behind closed doors” observations were complemented by diaries kept by home care workers and interviews with family members and agency staff.

In their symposium, Scales and colleagues highlighted three main themes from this innovative study. First, Scales’s presentation examined how different organizational practices can affect home care workers’ “empowered” capacity to provide person-centered care. For example, study participants appeared to feel empowered in their roles as long as they were adequately supported by supervisors—but isolated and disempowered when their contacts with supervisors was limited and/or punitive. These findings suggested that the right balance of empowerment and supportive supervision is required to encourage creative, individualized care rather than defensive, task-oriented care.

Drawing from the diary data, Travers identified the diverse range of everyday skills that home care workers bring to the job, as well as their sources of satisfaction and stress. Everyday skills included supporting clients’ ongoing capacity to exercise agency and fulfil social roles (such as wife and mother); sources of satisfaction included feeling competent, caring, and appreciated in their roles; and stressors included having to mediate among clients, relatives, and the home-care organization about care planning and delivery. Travers’s presentation highlighted the importance of giving home care workers the opportunity to “tell their own story” in order to appreciate the full extent of their roles.

Finally, Pollock discussed the interpersonal and emotional dimensions of home care. Her presentation highlighted how difficult it can be for workers to build authentic relationships with clients, which is important for care quality and continuity, as well as job satisfaction—while also fulfilling their hands-on responsibilities as paid workers. Along with the other presentations, Pollock’s findings emphasized the critical need to ensure—through training, scheduling, supervision, peer support, and other measures—that home care workers are prepared to fulfil the complex demands of their roles. The enthusiastic audience response to the symposium presentations underscored the relevance of the findings for efforts in many nations to improve both home care jobs and care.

The 21st IAGG World Congress was organized by the International Association of Geriatrics and Gerontology (IAGG) and hosted by the Gerontological Society of America. The next World Congress will be held in Argentina in 2021. 

Kezia Scales, PhD
About The Author

Kezia Scales, PhD

Senior Director of Policy Research
Kezia Scales oversees PHI’s national research strategies to effectively study the direct care workforce and its relationship to long-term care, providing an evidence base to inform public policies on this critical workforce.
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