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Presented at the Older HealthCare Workers Conference co-hosted by Health & Medicine Policy Research Group and the Great Lakes Centers for Occupational and Environmental Safety and Health (University …

Presented at the Older HealthCare Workers Conference co-hosted by Health & Medicine Policy Research Group and the Great Lakes Centers for Occupational and Environmental Safety and Health (University of Illinois at Chicago, School of Public Health)

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  • 1. Older Healthcare Workers: Addressing Health & Safety Challenges on the Job Jane Lipscomb Work and Health Research Center
  • 2. Overview
    • What do we know about aging and work?
    • Who is the direct care workforce (DCW)?
    • What are their work exposures and risk factors for illness and injury?
    • What is needed to protect older DCW ?
    • What are the consequences of inaction?
  • 3. Workshop Topics
    • Recruitment/workforce development
    • Training/promotional opportunities
    • Workplace design
    • Wellness/health promotion
    • Policy response
  • 4. “ Normal” Aging
    • Reduced physical strength, bone density, pulmonary oxygen uptake, exercise capacity, visual acuity.
    • Work limiting disabilities
      • 3.4% (age 18-28) vs. 13% (age > 60).
    • Median duration of work absence due to work injury
      • 5 days (age <25) vs. 12 days (age > 55).
  • 5. What we known about aging &work
    • All workers are aging, but those that are older continue to grow as a proportion of the population.
    • Older workers sustain more severe injuries, require more days away from work to recover, and die as a result of work-related injury at higher rates than younger workers.
    • Overall decrease in work ability with age but with substantial inter-individual variability.
  • 6. Incidence rates for injury/illness with source of injury: health care patient ( BLS, 2007) Age of worker Rate per 10,000 FTE
  • 7.                                                                             FIGURE 1-1 Schematic view of the impact of early and late environmental exposure on elder health outcomes. (NAS 2004, Health and Safety Needs of Older Workers)
  • 8. The Direct Care Workforce
    • AKA paraprofessionals (nurses aides, home health aides, personal- and home care aids).
    • “ The linchpin of the formal health care delivery system for older adults” (Retooling for an Aging America, IOM 2008).
    • 3 million workers employed in direct care occupational in 2006 (BLS, 2008).
      • 42% provide care in the home setting.
    • Personal- and home-care aids are the 2 nd and 3 rd fastest growing occupations between 2006-2016 (BLS, 2007).
    • Provide the bulk of the hands-on care in long-term care.
    • Help people perform crucial activities of daily living.
    • Bring stability, peace of mind, freedom, and positive energy into the lives of the people they support and their families.
    • Often provide some health care (range of motion exercises, blood pressure, etc.).
    • Often form close relationships with the people they assist.
  • 10. Demands on aging DCW population
    • Care for primarily elderly clients in the community.
    • Increasing work demands as less care is provided in the institutional acute care setting.
    • Poor compensation/benefits means needing to work into old age and in poor health.
  • 11. Why we need to protect this workforce
      • They are an essential community resource.
        • 30% of care recipients live alone
        • 20% have no other primary caregiver.
      • Workforce shortage to be met by aging workers.
      • DCWs are more likely to need to work (no paid sick leave) when ill.
      • They are at increased risk of illness and injury related to their income and lack of health insurance (30% have no health insurance coverage).
  • 12. Multiple safety challenges..
  • 13. Incidence Rates of Nonfatal Occupational Injuries HCSA sector and private industry, 2003-2006
  • 14. DCW risk factors for work related injury/illness at any age?
    • Little if any job training (no federal requirements for PCAs, 75 hrs for CNAs)
    • Few hazard controls (e.g. lifting devices, other engineering controls, PPE)
    • 40-60% turnover in 1 st year (PHI, 2005)
    • Only 50% of them have health insurance (24% - Medicaid /Medicare)
    • 38% are below 150% of poverty level
    • Because of low wages and benefits, they may need to work even if ill
      • CA PCAs (n=1614) reported working 2.2 days while sick in the past month (Delp, 2009)
  • 15. Personal Care Assistants Survey
    • PCAs practicing in an urban Midwestern area employed by two home health agencies.
    • PCAs were members of a large labor union.
    • Survey administered during a mandatory/ state required quarterly training session.
    • 980/1,150 PCAs present completed the 8 page self administered survey.
  • 16. Personal Care Assistants (IL) (n=767) Age <50 (471) N(%) Age >=50 (296) N(%) African Am race 344 (75.8) 239 (83.3)* Education <HS 73 (22.7) 63 (32.1) Self-rated health excellent 125 (26.9) 54 (18.5)* Client support (always) 205 (44.9) 164 (59.2)*
  • 17. IL PCAs (cont.) (n=767) Age <50 (471) N(%) Age >=50 (296) N(%) > 5 yrs in home care 205 (44.5) 194 (69.0)* >5 yrs with employer 78 (18.7) 102 (43.6)* Longest client care for > 5 yrs 50 (10.8) 80 (28.4)*
  • 18. Other Risk Factors
    • Among 855 IL DCWs, 27% reported having a flu shot in the previous year.
      • Flu shot was NOT associated with age, education or self reported general health.
    • Reasons given for not getting a flu shot (n=602):
      • Didn’t know where to get it (9%)
      • Too expensive (8%)
      • Not convenient (7%)
      • Couldn’t take off from work (7%)
      • Not important (28%)
            • Lipscomb et al, 2009
  • 19. Other findings: PCAs 50 years or older
    • Lower mean work demands - 4.3 vs. 5.2* (range 0-28)
    • Lower mean client demands – 5.3 vs.6.2* (range 0-20)
    • Lower mean burnout – 6.2 vs. 6.9 (0-28)
    • Reported more respect from client families and thinks of clients as family.
    • Reported more comfortable visiting difficult clients.
    • No difference in:
      • # clients per day
      • Working hours per week
      • Most work activities (i.e. cleaning, feeding, laundry)
      • Type of client (i.e. agitated, violent)
  • 20. Impressions…
    • Older PCAs more non-white, less education, lower self reported health status.
    • PCAs/all DCWs will need to work until an older age to meet workforce shortages.
    • PCAs may be able to avoid some physical demands but have few, if any workplace protections.
    • Older workers contribute skills and experience to caregiving.
  • 21. Application of health care worker protections to DCWs: a case study
    • Research documenting their risk.
    • Advocacy to include DCW in policy reform (DCA, others).
    • Stakeholder meeting around H1H1 (June 2008)
      • All direct care workers should be considered an essential part of the health care infrastructure and receive high priority for:
        • Vaccination
        • Antiviral prophylaxis and treatment
        • Access to and training in use of respiratory protection
        • Job and pay protections (i.e. paid sick leave)
          • Recommendations from a NIOSH sponsored stakeholder meeting, June 2008 in Baron et al, 2009
  • 22. Life Course Perspective (IOM, 2004)
    • A process that unfolds throughout life.
      • Cohort effects
      • Linked lives
      • Intracohort diversity
    • Reflects each individual’s social context and cumulative experience.
    • A working life trajectory (education, work, retirement) is not normative for the working poor, people of color, and/or women.
  • 23. Strategies to meet the needs of aging workers (Silverstein, AJIM 2008)
    • Interventions focused on work environment
    • Work (and retirement) organization
    • Health and fitness of individual workers
    • Social context of work
  • 24. Research Gaps and Summary: “Healthy Aging for Workers” Health Care Workgroup (2/2009)
    • How to understand the combined impact of age, tenure, “healthy worker effect” on research findings?
    • In what ways are older workers more susceptible to occupational diseases/ injuries?
    • What interventions will improve safety and reduce occupational exposures for older workers
  • 25. The cost of inaction?
    • Turn more DCW into health care patients
    • Increase the shortage of this critical workforce
  • 26. Acknowledgements:
    • University of Maryland School of Nursing
    • Work and Health Research Center
      • Jeanne Geiger Brown
      • Jeff Johnson
      • Joan Kanner
      • JiSun Choi
      • Carla Storr
      • Alison Trinkoff
    • Earl Dotter, Photo Journalist
    • National Institute for Occupational Safety and Health (NIOSH)
  • 27. For more information: [email_address] www.directcarealliance.org