Older Healthcare Workers: Addressing Health & Safety

Challenges on the Job

Jane Lipscomb

Work and Health Research Center

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?

Workshop Topics

• Recruitment/workforce development• Training/promotional opportunities• Workplace design• Wellness/health promotion• Policy response

“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).

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.

Incidence rates for injury/illness with source of injury: health care

patient (BLS, 2007)

0

1

2

3

4

5

6

7

16-19 20-24 25-34 35-44 45-54 55-64 65+

Rate

Age of worker

Rat

e pe

r 10

,000

FT

E

                                                                          

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)

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 2nd and 3rd fastest growing occupations between 2006-2016 (BLS, 2007).

DIRECT CARE WORKERS • 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.

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.

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).

Multiple safety challenges..

Incidence Rates of Nonfatal Occupational Injuries

HCSA sector and private industry, 2003-2006

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 1st 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)

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.

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)*

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)*

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

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)

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.

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

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.

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

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

The cost of inaction?• Turn more DCW into health care patients• Increase the shortage of this critical workforce

Acknowledgements:

University of Maryland School of NursingWork 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)

For more information:lipscomb@son.umaryland.edu

www.directcarealliance.org

For more information:lipscomb@son.umaryland.edu

www.directcarealliance.org