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Background The need for home care workers (HCWs) is rapidly growing in Norway due to the increasingly growing elderly population. HCWs are exposed to a number of occupational hazards and physically demanding work tasks. Musculoskeletal disorders, stress, exhaustion, high sick leave rates and a high probability of being granted a disability pension are common challenges. This qualitative study explored the views of HCWs on how working conditions affect their safety, health, and wellbeing. Methods A descriptive and explorative design was utilised using semi-structured individual interviews with eight HCWs from three home care units in a middle-sized Norwegian city. Interviews were conducted in the Norwegian language, audio-recorded, and transcribed verbatim. The data was analysed by systematic text condensation. Key data quotes were translated into English by the authors. Results HCWs reported that meaningful work-related interactions and relationships contributed to their improved wellbeing. Challenging interactions, such as verbal violence by consumers, were deemed stressful. The unpredictable work conditions HCWs encounter in users’ homes contributed to their exposure to environmental hazards and unhealthy physical workloads. This was the case, although the employer promoted ergonomic work practices such as ergonomic body mechanics when mobilising and handling of clients, using safe patient handling equipment. HCWs perceived high level of individual responsibility for complying with company safety policies and practices, representing a health barrier for some. Organisational frameworks created unhealthy work conditions by shift work, time pressure and staffing challenges. Performing tasks in accordance with HCWs professional skills and identity was perceived as health-promoting. Conclusions This study suggests that unpredictable working conditions at users’ home can adversely affect the safety, health, and wellbeing of HCWs. The interaction between the unpredictable environment at users’ homes, HCWs’ perceived high level of individual responsibility for complying with company safety policies and practices, and staffing challenges due to sickness-related absences upon the workplace creates tense work conditions with a negative influence on HCWs health.

PurposeThe purpose of the scoping review is to develop understandings around the high demand for in-home healthcare for the aged and how to find ways to better support declining numbers of in-home care workers and healthcare professionals. The scoping review highlights the role of human resource management (HRM) in this sector.Design/methodology/approachThis scoping review of literature takes a systematic approach to identify themes on the aged care sector and levels of support for in-home care. We map the literature from specific databases to find themes.FindingsIt is important for HRM of aged care service providers to understand the key issues around homecare workers and healthcare professionals. There are key issues for stakeholders, such as clients’ health needs, organizations struggling to recruit and retain healthcare workers, and it is critical to know how such issues impact on clients and the healthcare workforce.Originality/valueThere is a dearth of literature on in-home care for the aged, and therefore, we contribute to understandings about the competing pressures surrounding the demand for in-home care versus the declining number of homecare workers and professional healthcare workers in this sector. We highlight the lack of HRM support from aged care providers and the impact on homecare workers.

As the locus of long-term care in the United States shifts from institutions to the community, paid caregivers (i.e., home health aides, personal care attendants) are providing more hands-on care to persons with dementia living at home. Yet, little is known about how family caregivers engage with paid caregivers. We conducted in-depth, semi-structured interviews (n = 15) with family caregivers, of persons living at home with severe dementia, and enriched our findings with data from a second cohort of family caregivers of persons with dementia (n = 9). Whether paid caregivers were hired privately or employed via a Medicaid-funded agency, family caregivers reported that they needed to manage paid caregivers in the home. Core management tasks were day-to-day monitoring and relationship building with family caregivers; training paid caregivers and coordinating care with homecare agencies was also described. In order to support family caregivers of individuals with dementia at home, it is important consider their preferences and skills in order to effectively manage paid caregivers. Support of efforts to build a high-quality paid caregiving workforce has the potential to improve not only care delivered to persons with dementia, but the experiences of their family caregivers.

Introduction Older adults may experience a wish to die in the context of deteriorating health, a loss of autonomy, loneliness, or depression. Home care workers may likewise experience burden or symptoms of depression as a result of prolonged contact with this physical and emotional suffering. Training initiatives that can support the well‐being of home care workers are therefore important. Aim To describe the typical profile of older adults who express a wish to die to their home care worker, and to examine whether a psycho‐educational intervention for care workers exploring the end‐of‐life process and self‐care strategies had an impact on the older adult's wish to die and on the care worker's perceived burden and depressive symptoms. Design Quasi‐experimental, longitudinal study involving non‐randomized experimental and control groups and follow‐up at 3–6 months post‐intervention. Methods At the start of the study, all care workers (n = 126) provided sociodemographic information (age, gender) for themselves and the care recipient, and completed the Karnofsky Performance Status scale and the Assessment of the Frequency and Extent of the Desire to Die (AFEDD) interview to provide a baseline measure of the care recipient's functional status and wish to die. They also completed the Beck Depression Inventory (BDI) and Zarit Burden Interview (ZBI) as a measure of their own perceived burden and depressive symptoms. The AFEDD, BDI, and ZBI were completed again by care workers at 3 and 6 months post‐intervention. Results The typical profile of care recipients was a woman aged 85.5 years who required considerable support and assistance and who had at least occasionally experienced a wish to die, although these thoughts were not always verbalized. Scores on the AFEDD remained relatively stable over the follow‐up period in both the control and experimental groups. There was no significant association between the older adult's wish to die and depressive symptoms in the care worker across the study period. However, a positive and significant correlation between a wish to die in the older adult and perceived burden in the care worker was observed at 6 months post‐intervention in both the total sample (p = 0.032) and among controls (p = 0.028). By contrast, this significant association was not found for care workers in the experimental group (p = 0.376), suggesting that the psycho‐educational intervention may have had a protective effect. Conclusion Although further studies are needed to corroborate and extend these findings, the results suggest that psycho‐educational interventions aimed at increasing home care workers' understanding of the end‐of‐life process and which introduce them to self‐care strategies may help to reduce their perceived burden when the older person for whom they are caring expresses a wish to die. Clinical Relevance Home care workers may find it challenging to care for an older adult who expresses a wish to die. Psycho‐educational interventions that enhance care workers' understanding of the end‐of‐life process and teach them self‐care strategies could help to support their well‐being and their ability to provide adequate care.

Background Chronic pain is a prevalent and costly problem that often has occupational origins. Home care workers (HCWs) are at high risk for work-related injuries, pain, and disability. Current treatments for chronic pain emphasize medications, which are an inadequate stand-alone treatment and can produce significant adverse effects. Methods In this translational study, we will adapt an established work-based injury prevention and health promotion program (COMmunity of Practice And Safety Support: COMPASS) to address the needs of HCWs experiencing chronic pain. COMPASS employs peer-led, scripted group meetings that include educational content, activities, goal setting, and structured social support. The translated intervention, named COMPASS for Navigating Pain (COMPASS-NP), will be delivered in an online group format. Safety protections will be strengthened through an ergonomic self-assessment and vouchers for purchasing ergonomic tools. Educational content will integrate a self-management approach to chronic pain using proven cognitive-behavioral therapy (CBT) principles. We will use a mixed-methods hybrid type 2 evaluation approach to assess effectiveness and implementation. A cluster-randomized waitlist control design will involve 14 groups of 10 HCWs ( n  = 140) recruited from Washington, Oregon, and Idaho. Half of the groups will be randomly selected to complete the intervention during the first 10 weeks, while the waitlist groups serve as controls. During weeks 10–20, the waitlist groups will complete the intervention while the original intervention groups complete a follow-up period without further intervention. Our primary hypothesis is that COMPASS-NP will reduce pain interference with work and life. Secondary outcomes include injury and pain prevention behaviors, pain severity, changes in medication use, risk for opioid misuse, well-being, physical activity, and sleep. Qualitative data, including phone interviews with group facilitators and organizational partners, will evaluate the implementation and guide dissemination. Discussion The results will advance the use and knowledge of secondary prevention interventions such as ergonomic tools and cognitive behavior therapy, to reduce injury, pain, and disability and to encourage appropriate uses of analgesic medications among HCWs. Trial registration ClinicalTrials.gov NCT05492903. Registered on 08 August 2022

Climate change is intensifying the frequency and severity of heatwaves, posing growing risks for workers. Home care workers face heightened heat risks due to physically demanding tasks, rising patient needs, frequent travel, and limited access to cooling environments. This study aims to causally evaluate the effectiveness of an app-based intervention (REHEAT strategy) in reducing adverse effects of heatwaves among Swiss home care workers. This multicenter, unblinded, randomized controlled trial (RCT) will involve 350 home care workers from the regions of Northern and Southern Switzerland. Participants will be randomized (1:1) into intervention and control groups, stratified by sex, age group, and geographical location. The intervention group will use the REHEAT app from June to September 2025, while the control group will gain access only after summer 2025. Both groups will be monitored over the summer using a wrist-worn wearable device (smartwatch), online questionnaires, diaries and cognitive tests. The impact of the REHEAT intervention will be evaluated using an Intention-To-Treat (ITT) approach to provide reliable real-world effect estimates, supplemented by Local Average Treatment Effects (LATE) analyses to assess impact based on participant exposure and compliance levels. Primary outcomes include strain accumulation, cognitive performance, emotional distress, sleep, night recovery, and mental and physical health. Outcomes will be analyzed longitudinally with mixed-effects models, while LATE will be estimated using app usage as an instrumental variable in generalized linear mixed models. At the time of submission, recruitment had been successfully completed, with a total of 350 participants enrolled in accordance with the study protocol. The intervention and data collection phases are ongoing, and no outcome data have yet been accessed or analyzed. The findings will inform the development of occupational health interventions in response to heat-related stressors and support climate change adaptation policies for health sector workers.

OBJECTIVES: Evidence suggests that emotional dissonance, the imbalance between true feelings and those displayed to meet work standards, heightens the risk of mental distress. In nursing occupations, exerting such emotional effort is a part of the job role. Drawing from the job demands–resources model, high-quality leadership is a resource that may assist employees in coping with stressors. We examined whether quality of leadership mitigated the potential adverse impact of emotional dissonance on mental health. METHODS: In 2019, 1426 home-care workers from 130 organizational units were surveyed, with follow-ups after 8 and 14 months. Prospective associations between emotional dissonance (the Frankfurt Emotion Work Scales) and mental distress (Hopkins Symptom Checklist, HSCL-5), including interactions between emotional dissonance and leadership behaviors (Nordic Questionnaire for Psychological and Social Factors at Work), were determined using lagged linear mixed models. RESULTS: Emotional dissonance was positively associated with mental distress (adjusted P<0.05), whereas supportive, empowering, and fair leadership were negatively associated with mental distress (adjusted P<0.05). All three investigated sources of leadership behaviors moderated the direct association between emotional dissonance and mental distress (adjusted P<0.05). Emotional dissonance and mental distress were reciprocally related; an increase in either will heighten the level of the other. Leadership behaviors did not moderate the reversed association between emotional dissonance and mental distress (adjusted P>0.05). CONCLUSIONS: Supportive, empowering, and fair leadership buffers the association of emotional dissonance on mental distress. Strategic interventions that enhance the quality of leadership may help prevent mental distress among employees in professions with emotionally demanding tasks.

Background The Dementia Knowledge Assessment Scale (DKAS) is a reliable and valid measurement of dementia knowledge for diverse allied health professionals but its traditional Chinese version has not been formally validated yet. The purpose of this study was to translate the DKAS from English to traditional Chinese and evaluate its psychometric properties among home care workers in Taiwan. Methods The DKAS scale was translated into traditional Chinese through a forward translation and back translation process following the cross-cultural translation guideline. A total of 285 home care workers in eastern Taiwan were recruited using convenience sample. A total of 252 participants completed the questionnaires, giving a response rate of 88.4%. We tested the construct validity by confirmatory factor analysis (CFA) and evaluated the reliability by internal consistency. Results The results of the CFA supported the 25-item, four-factor model for the DKAS-TC. The DKAS-TC achieved a good overall Cronbach’s alpha of .93 and McDonald’s omega of 0.94 with acceptable subscales McDonald’s omega ranged from .77 to .82. Conclusions The DKAS-TC has adequate construct validity and reliability and can serve as an assessment tool to evaluate the knowledge level of home care workers in a dementia training program in Taiwan. The dementia knowledge level among home care workers in Taiwan was inadequate. There is a need for developing suitable dementia care training tailored to their learning needs and educational levels, and to improve their quality of care for those with dementia.