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PubMed1992

National uniformity for paraprofessional title, qualifications and supervision. Homemaker-Home Aide Association of America.

The core services around which a long-term care strategy should be forged are those cost-effective services that are performed by home care aides. It is essential that the duties and qualifications of these paraprofessionals be nationally defined and that credible standards be set; otherwise, the home care field will not be in a position to participate in policy discussions on a national long-term care system. Following is a draft position statement, which was developed by the Homemaker-Home Aide Association of America (HHHAAA) to begin discussions on home care paraprofessionals' title, function, and qualifications. This paper was endorsed in principle by the National Association for Home Care's (NAHC) Board of Directors in January 1992; HHHAAA is in the process of soliciting comments from interested parties and expects the statement to evolve based on continuing discussions. In late March, for example, the Advisory Board made additional changes and clarifications that may be incorporated in the future. Special thanks go to Ken Wessel of the Visiting Homemaker Service of Passaic County in Patterson, New Jersey, and an HHHAAA Advisory Board member, for his significant contribution to the development of this paper.

Caregivers↗
PubMed2002

Estimating paid and unpaid hours of personal assistance services in activities of daily living provided to adults living at home.

OBJECTIVE: To estimate the total hours of paid and unpaid personal assistance of daily living provided to adults living at home in the United States using nationally representative household survey data. DATA SOURCES: The Disability Followback Survey of the National Health Interview Survey on Disability (NHIS-D) conducted from 1994 to 1997. DATA COLLECTION/EXTRACTION METHODS: Data were obtained on persons receiving help with up to 5 ADLs and 10 IADLs, for up to 4 helpers, including the activities they helped with, whether the helper was paid or not, and the number of hours of help provided in the two weeks prior to the survey. The sample consists of 8,471 household-resident adults ages 18 and older receiving help with personal assistance. About 22 percent of the sample has missing data on hours, which we impute by multiple regression models using demographic, ADL, and IADL variables. FINDINGS: We estimate that 13.2 million noninstitutionalized adults receive an average of 31.4 hours per week of personal assistance in ADLs and IADLs per week, with 3.2 million people receiving an average of 17.6 hours of paid help and 11.7 million receiving an average of 30.7 hours of unpaid help. More persons ages 18-64 received help than those ages 65 and older (6.9 versus 6.2 million), but working-age recipients had fewer hours (27.4 versus 35.9) per week, due in part to less severe levels of disability. CONCLUSIONS: Personal assistance provided to adults with disabilities amounts to 21.5 billion hours of help per year, with an economic value in 1996 approaching $200 billion. Only 16 percent of this total is paid, representing $32 billion in home health services spent annually. This study, the first to estimate hours of assistance for both working-age and older adults, documents that older persons are more likely to receive paid personal assistance, while working-age people rely to a greater extent on unpaid help. This study begins to articulate the division of labor in the provision of personal assistance. Estimates of paid and unpaid hours of help by number of ADLs should inform policy concerning eligibility boundaries in long term care.

Activities of Daily Living↗
PubMed2001

Elders' perceptions of formal and informal care: aspects of getting and receiving help for their activities of daily living.

A purposive and convenience sample of 16 women and four men receiving informal and formal care for their activities of daily living either at home or institutions in Southeast Washington, USA was interviewed. Qualitative findings related to asking for help, getting and receiving help, interpersonal aspects of receiving help, and met and unmet needs are reported. Some seniors found it more difficult to ask for and accept help and there were gender differences, with men tending to adopt a more logical and pragmatic approach while women viewed receiving help as a loss of independence and an invasion of privacy. Intimacy and nudity were also threats for women. Three styles of adjustment and acceptance were identified within the data and related to positive acceptance, resigned acceptance and passive acceptance. There appeared to be a relationship between independence and control, with elders losing some independence but retaining control through choice, payment and involvement in decision making. Reciprocity was found to bring added value to relationships between care providers and elders, with a rhythm and symmetry developing in relationships where needs were known, anticipated and met. Seniors should be encouraged to plan for their future and to find out about local help and services available to them in advance of their requiring any assistance.

Activities of Daily Living↗
PubMed2002

Does informal care from adult children reduce nursing home admissions for the elderly?

Despite the policy importance, particularly as society ages, little is known about the impact of informal care on nursing home admissions. This paper jointly models the receipt of regular help from adult children and subsequent nursing home care, using data from the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD). Results indicate that frequent help from children with basic personal care reduces the likelihood of nursing home use over a subsequent two-year period by about 60% for disabled Americans age 70 and older. However, we found no significant reduction in nursing home admissions when help was measured more broadly to include assistance with chores and errands.

Activities of Daily Living↗
PubMed1993

The shared aide program. The cluster care experience.

Traditional home care services use a one-on-one caregiver-to-client approach in time blocks. In urban setting caregivers may cross each other's paths as aides from several agencies each visit several patients in one building. Cluster care services use a team approach by tasks, consolidating visits and providing a more coordinated, cost-effective approach to services.

Allied Health Personnel↗
PubMedDate not supplied

The personal assistance workforce: trends in supply and demand.

The workforce providing noninstitutional personal assistance and home health services tripled between 1989 and 2004, according to U.S. survey data, growing at a much faster rate than the population needing such services. During the same period, Medicaid spending for such services increased dramatically, while both workforce size and spending for similar services in institutional settings remained relatively stable. Low wage levels for personal assistance workers, which have fallen behind those of comparable occupations; scarce health benefits; and high job turnover rates highlight the need for greater attention to ensuring a stable and well-trained workforce to meet growing demand.

Activities of Daily Living↗
PubMed2000

The home health aide. Scarce resource in a competitive marketplace.

Direct-care staff--home health aides and personal care attendants--are the very point where home care "touches the client." Yet our system of care delivery has never been designed for the needs of the direct-care worker. Today we are paying the price: Across the country, our industry is experiencing the highest rates of direct-care vacancies and turnover in its history. The very future of our industry now rests on our ability to attract workers within an increasingly competitive labor market. In order to survive, let alone provide high-quality care, the home care industry must restructure paraprofessional employment.

Health Policy↗