Keynote Jane Lipscomb


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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 of Illinois at Chicago, School of Public Health)

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Keynote Jane Lipscomb

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