Home Health Aides Been Abuse From Family Members

Occup Environ Med. 2019 Jul; 76(seven): 448–454.

Original article

Home care aides' experiences of verbal abuse: a survey of characteristics and risk factors

Nicole D Karlsson

¹ Department of Public Health, University of Massachusetts, Lowell, Massachusetts, United states,

Pia G Markkanen

¹ Department of Public Health, University of Massachusetts, Lowell, Massachusetts, The states,

David Kriebel

^ane Department of Public Health, Academy of Massachusetts, Lowell, Massachusetts, USA,

Rebecca J Gore

² Section of Biomedical Engineering, University of Massachusetts, Lowell, Massachusetts, USA,

Catherine J Galligan

¹ Department of Public Health, Academy of Massachusetts, Lowell, Massachusetts, USA,

Susan R Sama

^one Department of Public Health, University of Massachusetts, Lowell, Massachusetts, USA,

Margaret One thousand Quinn

^one Department of Public Health, University of Massachusetts, Lowell, Massachusetts, Us,

Received 2018 Nov 22; Revised 2019 Mar 24; Accepted 2019 April xv.

Abstract

Objective

Violence from care recipients and family members, including both verbal and physical abuse, is a serious occupational hazard for healthcare and social assistance workers. Nigh workplace violence studies in this sector focus on hospitals and other institutional settings. This study examined verbal abuse in a large dwelling house care (HC) aide population and evaluated risk factors.

Methods

We used questionnaire survey data collected as part of a larger mixed methods study of a range of working weather amongst HC aides. This paper focuses on survey responses of HC aides (due north=954) who reported on verbal abuse from non-family clients and their family members. Risk factors were identified in univariate and multivariable analyses.

Results

Twenty-two per cent (n=206) of aides reported at to the lowest degree 1 incident of verbal abuse in the 12 months before the survey. Three factors were institute to be of import in multivariable models: clients with dementia (relative run a risk (RR) 1.38, 95% CI 1.07 to 1.78), homes with also lilliputian space for the adjutant to work (RR 1.52, 95% CI 1.17 to 1.97) and anticipated piece of work hours (RR 0.74, 95% CI 0.58 to 0.94); two additional factors were associated with verbal corruption, although not every bit strongly: having clients with limited mobility (RR one.35, 95% CI 0.94 to one.93) and an unclear program for care delivery (RR 1.27, 95% CI 0.95 to i.69). Aides reporting verbal abuse were xi times as probable to as well report physical corruption (RR 11.53; 95% CI 6.84 to 19.45).

Conclusions

Verbal abuse is common amongst HC aides. These findings suggest specific changes in piece of work system and training that may help reduce verbal corruption.

Keywords: workplace violence, verbal corruption, home intendance, habitation wellness aides, occupational health

Key messages

What is already known about this subject?

• Violent behaviours of care recipients towards healthcare workers are widespread and can lead to occupational injuries and disease, every bit well as job dissatisfaction and burnout.

• Studies often focus on concrete assault; all the same, verbal abuse also causes serious psychological and physiological harm.

• Habitation intendance (HC) is a significant and chop-chop growing segment of healthcare and social services with characteristics both similar to and distinct from facility-based care.

What are the new findings?

• HC aides ofttimes reported exact abuse by clients and clients' family members.

• Aides caring for clients with dementia, working in a home with likewise little infinite to perform intendance tasks and having unpredictable work schedules were constitute to be risk factors for verbal abuse.

• There was suggestive evidence that unclear plans for delivering intendance and having clients with limited mobility were as well risk factors.

• Verbal abuse was strongly associated with physical corruption.

How might this bear upon on policy or clinical exercise in the foreseeable future?

• Verbal abuse of HC aides by clients and family unit members is common and approaches to reducing it should be a priority for HC employers.

• The report findings suggest specific factors to target with policy and preparation interventions.

Background

Violence is a serious occupational run a risk in the The states healthcare and social help sectors and is recognised equally a problem in demand of additional research and preventive interventions.1–10 The objectives of this study were to quantify the risks of verbal abuse directed at workers from clients and clients' family members in a large US population of dwelling house care (HC) aides and to evaluate risk factors occurring at the aide, customer and piece of work-organisational levels.

For home health services, rates of workplace violence for injuries leading to days abroad from work as recorded past the U.s.a. Bureau of Labour Statistics increased 87% from 2006 to 2016.11 While public focus is often on physical assault, healthcare and social assistance workers may experience persistent serious health consequences from non-physical types of violence, including verbal corruption, from those to whom they are delivering care.12 13

Home-based care and services proceed their rapid growth internationally. In 2016 in the Usa, there were approximately 2.9 1000000 abode health and personal intendance aides with 1.2 1000000 new aide jobs projected by 2026.14 There are numerous occupational titles for aides working in HC, including home wellness aide, certified nursing banana, hospice aide and personal care aide. Here, nosotros use the overarching industry term 'home intendance adjutant' to refer to the full range of occupational titles because at that place is considerable overlap in job duties. Most aides assist someone in their home with mobility and activities of daily living such as physical exercising, bathing, dressing, toileting, skin care, nutrient grooming and house cleaning.15 In the U.s., HC recipients may be chosen consumers, clients or patients, depending on the medical or social service system that provides their intendance; in this paper, 'customer' refers to all care recipients. Aides mainly are hired by a individual business (agency) or directly by clients or their families. The majority of HC aides are women, depression-wage workers and increasingly racial/ethnic minorities and immigrants.16 Dissimilar aides in institutional settings, HC aides typically work alone. These social and work organisational factors brand aides peculiarly vulnerable to violence.

Definitions of occupational violence vary only generally include a spectrum of physical, verbal, emotional and sexual behaviours.17 Exact acts are described in research with varying terminology, including violence, corruption and aggression. In this study, challenging verbal behaviours by clients are referred to as abuse. The US National Institute for Occupational Safety and Wellness (NIOSH) defines verbally calumniating behaviours equally workplace violence.xviii

In that location is no gold standard measurement tool for quantitative research on occupational violence. Data from HC studies are self-reported and have a wide distribution; for instance, frequency of verbal abuse amid HC aides and similar jobs ranges from 26% to 65.ane%2 3 xix–21 and of physical violence from 3.3% to 44.6%.2 3 vii 19 21

This paper follows a conceptual model for the relationship between exact and physical violence (effigy 1), whereby exact abuse may straight pb to harmful psychological outcomes and as well predict physical abuse leading to concrete and psychological harm.2 8 19 22–27 Inquiry suggests that verbal and physical abuse are strongly correlated in healthcare.25 As well, frequent verbal abuse may be a stronger predictor of workers' perception of safety than less frequent incidents of physical abuse.27 Although literature is limited on the potential escalation of exact abuse to concrete abuse in the workplace, it is a recognised pattern in intimate partner violence research.26 Behaviour patterns in partner violence may be relevant to HC because aides and clients are frequently in long-term intendance relationships with family unit like bonds described every bit 'fictive kinship'.28

A conceptual model of different potential pathways from verbal abuse to harmful outcomes based on the literature.

HC workers may be particularly vulnerable to impacts from verbal abuse, every bit the isolated nature of their jobs and requirements of client privacy leave them with fewer resources for social support that can assist moderate the stress response. In HC, verbal abuse has been found to be related to negative emotional reactions; burnout, stress, sleep issues and depression.2 8 22 Abuse has been associated with decreased job satisfaction; and emotional hazards, including difficult, abusive clients, take been associated with increased worker turnover.23 24

Methods

The source of information for this report, the Safe Home Care Survey, was a self-administered questionnaire survey completed by HC aides as part of a larger mixed methods enquiry initiative chosen the Safe Home Care Project. The questionnaire and survey administration methods were grounded in a formative qualitative research stage using presurvey focus groups with aides and in-depth interviews with agency and client employers and labour representatives.29 Postsurvey focus groups and interviews also were conducted to gain insights about the survey results and possible preventive interventions (findings to be reported elsewhere). All aides gave informed consent before participation.

The survey, conducted between September 2012 and April 2013, assessed working conditions experienced in the prior 12 months. Agency-hired aides were recruited from seven HC agencies (16 sites) in Massachusetts, United states. Aides hired directly by HC clients or clients' families ('client-hired') were recruited via their labour wedlock. The original survey population totalled 1249 HC aides aged at to the lowest degree 18 years (634 agency-hired, 615 client-hired). The population in this study is a subset comprising 954 HC aides who reported caring for non-family members. The study was restricted to clients who were non related to aides because the literature suggests that family unit caregivers may contextualise harmful behaviours differently than non-family unit caregivers.30 The survey design, administration, recruitment, response rates and overall findings were published previously.15 Following our previously published methods, the questionnaire was piloted amongst HC aides not participating in the written report.31 The questionnaire survey consisted of two parts. Part 1 gathered information on individual aides ('adjutant-level'), such as demographics, health outcomes and general weather condition of employment. Function two ('visit-level') gathered detailed information on work practices and home and customer conditions from specific visits each adjutant conducted with up to five HC clients within the prior month. This study's HC aide population contributed reports on 3189 visits.

The survey questions and the result and risk factor variables were informed by the formative research phase of this report,29 2007 National Home Health Aide Survey32 and Massachusetts Nurses Association Survey on Workplace Violence/Corruption.33 We divers the incidence of verbal abuse using response to a survey question request whether an aide had experienced at least i incident of exact abuse within the past 12 months from a customer or customer's family member. Four forms of verbal abuse were ascertained from the survey responses: 'being yelled at or spoken to in an angry or humiliating tone'; 'made to feel bad about myself'; 'racial, ethnic, religious or other personal insults' and 'verbal threat of harm'.

Adjutant risk factor variables were synthetic from function 1 of the survey and represented demographic characteristics which might make an adjutant more or less vulnerable or likely to experience verbal abuse. These included age, race, ethnicity, nativity and economical vulnerability. Age was constructed every bit a binary variable divided at 48 years, the median age of the study population, which closely corresponded with a national HC median age of 47.16 Economic vulnerability was identified when aides reported that they worked in their current HC job because they could not find another job, and/or that they relied on it for wellness insurance.

Potential work-organisational risk factors included how the adjutant was hired (agency-hired vs customer-hired), job stability (based on survey responses: "I have a stable chore, and I'm not agape of losing it") and any use of safe patient handling devices for client mobilisation. Having anticipated work hours was indicated when aides reported that their hours were 'usually the aforementioned, calendar week to week', whereas those reporting that their hours 'vary somewhat' or were 'highly unpredictable' were considered to have unpredictable work hours. An assessment of general safety measures on the job was derived from two questions: whether their employer provided gloves and whether they knew how to report claret exposures and injuries from medical sharps. Two additional variables were derived from visit-level data: whether, during a specific visit, the aide had the fourth dimension needed to perform care tasks and whether clients had a conspicuously specified plan for their care (a 'care programme'). The care plan is normally adult by a case director employed by an agency or social services to assess clients' needs for HC; it may contain instructions for the aide and for the client.

Client characteristics chosen as potential adventure factors were related to client health conditions, client behaviours and home environment conditions. An aide was considered exposed if she reported the hazard factor being present during at least i of the reported visits.

Log-binomial regression was used to estimate relative risks (RR) of exact abuse inside the by 12 months. After univariate modelling, confounding was investigated by multivariable modelling. Potential take a chance factor variables were added one at a time to the log-binomial model for adventure of verbal abuse, choosing from all variables with a p value <0.20 in univariate analysis. Variables were retained in multivariable models when their p values were <0.05. Confounding was divers as a change in a coefficient of >10%. 2-way interactions amidst variables in the final model were investigated using production terms.

Results

In full, 206 aides (22%) reported at to the lowest degree one incident of verbal corruption in the 12 months prior to the survey: beingness yelled at or spoken to in an angry or humiliating tone (17%); made to feel bad about myself (10%); racial, ethnic, religious or other personal insults (6%) and verbal threat of harm (v%). Aides could report more than one kind of verbal abuse: amidst the 22% who reported any exact abuse, 51% experienced more one kind and 5% experienced all four kinds. Physical abuse was less common than verbal abuse (seven.four% vs 22%, respectively); notwithstanding, the two types of corruption were strongly associated. Aides who reported verbal abuse were 11 times every bit probable to as well report physical corruption within the past 12 months every bit aides who did non report exact abuse (RR eleven.53; 95% CI 6.84 to 19.45). The number of physical corruption incidents was insufficient for risk factor modelling.

Adjutant demographic characteristics

Age was the only aide characteristic that was significantly associated with hazard of verbal abuse in univariate assay (table 1); those above the median age 48 were less likely to report having experienced exact abuse (RR 0.59, 95% CI 0.45 to 0.76). We further investigated effect modification and confounding past historic period of the work-organisational and client-related adventure factors.

Table 1

Home intendance (HC) aides' demographic characteristics and univariate relative risks (RR) of reporting verbal abuse in the by 12 months, Condom Domicile Intendance Survey, Massachusetts, USA

	Number of aides (n=954)	Verbal corruption in past 12 months*
		Number reporting verbal abuse	RR	95% CI
Age (years)
>48	455	72	0.59	0.45 to 0.76
≤48†	476	128
Missing	23	six
Gender
Male	93	19	0.94	0.62 to 1.44
Female person†	858	186
Missing	three	1
Race
Not-white or mixed race	399	fourscore	0.xc	0.69 to 1.17
White†	431	96
Missing	124	xxx
Hispanic/Latino
Yes	154	37	ane.11	0.82 to 1.52
No†	760	164
Missing	40	five
Born exterior the USA
Yeah	383	78	0.91	0.71 to 1.17
No†	566	127
Missing	5	i
Immigrant within past 5 years
Yeah	55	12	1.01	0.60 to i.69
No†	892	193
Missing	seven	1
Economic dependence on job
Yes‡	225	55	one.18	0.90 to one.55
No†	729	151

Work-organisational take chances factors

In the univariate analysis, aides with predictable hours were less probable to report exact abuse than those with unpredictable hours (RR 0.65, 95% CI 0.51 to 0.83) (table two). Aides hired directly by a client were somewhat less likely to report verbal abuse than those hired by agencies (RR 0.76, 95% CI 0.58 to 1.00). The following factors were associated with increased risk of exact abuse: an aide non having the time needed to perform the care work (RR i.threescore, 95% CI ane.17 to ii.xviii), using a client handling device (RR 1.36, 95% CI one.06 to 1.75) and not having a clear intendance program (RR i.62, 95% CI one.21 to 2.17).

Table two

Univariate models of relative risks (RR) of exact abuse reported by home care aides in the by 12 months, by work-organisational and client-related characteristics, Condom Home Intendance Survey, Massachusetts, USA

	Number of aides (n=954)	Exact corruption in by 12 months*
		Number reporting verbal abuse	RR	95%  CI
Work-organisational characteristics
Hire blazon
Client	330	59	0.76	0.58 to i.00
Agency†	624	147
Anticipated hours
Yes	614	113	0.65	0.51 to 0.83
No†	318	90
Missing	22	3
Job is stable
Yes	637	141	0.97	0.73 to 1.28
No†	228	52
Missing	89	13
Did not accept the time I needed
Yeah‡	100	33	one.60	1.17 to 2.eighteen
No†	828	171
Missing	26	two
Use whatever client handling/transfer device
Yep	403	102	1.36	one.06 to 1.75
No†	489	91
Missing	62	13
Safety measures
Aide is provided with gloves and knows where to study blood exposures	762	170	0.79	0.53 to i.xvi
Aide lacks ane or both of the in a higher place†	74	21
Missing	118	15
Did not have a clear intendance plan
Aye‡	117	39	1.62	1.21 to 2.17
No†	794	163
Missing	43	four
Customer characteristics
Language discordance
Aye§	184	45	1.sixteen	0.87 to 1.55
No†	766	161
Missing	4	0
Dementia
Yes§	355	106	1.65	1.29 to 2.10
No†	513	93
Missing	86	vii
Mental affliction/psychological issues
Aye§	304	91	1.58	one.24 to ii.01
No†	576	109
Missing	74	6
Limited mobility
Yes§	709	173	1.73	i.21 to 2.47
No†	213	30
Missing	32	3
Customer smokes indoors
Yes§	238	63	1.29	1.00 to i.67
No†	688	141
Missing	28	2
Too little space made information technology difficult to piece of work
Yep§	219	76	ane.92	ane.51 to 2.44
No†	708	128
Missing	27	2

Client-related risk factors

All of the client variables were associated with increased risk of verbal abuse in univariate analyses except not sharing a mutual language with the client—called linguistic communication discordance (table 2). Reporting working in a dwelling house with besides trivial infinite was most strongly associated with gamble of verbal abuse (RR ane.92, 95% CI i.51 to 2.44), followed by three customer health conditions: having a client with express mobility (RR ane.73, 95% CI 1.21 to 2.47), with dementia (RR 1.65, 95% CI 1.29 to 2.ten) and with mental illness or psychological issues (RR 1.58, 95% CI ane.24 to ii.01). Risk of verbal abuse was too associated with having a client who smoked indoors (RR one.29, 95% CI 1.00 to 1.67).

Multivariable model

In the final model, five take a chance factors were constitute to be associated with exact abuse (table three, model i). Client-related factors were: having limited mobility, having dementia and too footling space in the customer's home for the aide to work. At the work-organisational level, having an unclear intendance program was a gamble gene while anticipated work hours was protective. Once these factors were included in the model, at that place was no departure in take chances of verbal abuse between those aides hired direct by clients versus those hired by agencies.

Table 3

Final models estimating the association between important run a risk factors and risk of reporting verbal abuse in the past 12 months, by piece of work-organisational and client-related hazard factors, Safe Dwelling Care Survey, Massachusetts, USA

	Model 1: RR 95% CI	Model 2: adjusted for age* RR 95% CI
Customer with limited mobility	1.47	1.35
	1.03 to two.10	0.94 to 1.93
Customer with dementia	1.39	1.38
	1.08 to 1.79d	ane.07 to one.78
Likewise footling space to work	1.51	i.52
	1.sixteen to 1.95	ane.17 to ane.97
Unclear care program	ane.35	1.27
	1.01 to 1.81	0.95 to 1.69
Predictable hours	0.73	0.74
	0.58 to 0.94	0.58 to 0.94

Later on adjusting for age, the only adjutant characteristic associated with verbal abuse, three work-organisational and client characteristics were significantly associated with verbal abuse: a client having dementia, likewise little space to piece of work and predictable piece of work hours (table three, model 2). Age did not derange the clan between verbal abuse and the work-organisational or client-related factors in the model. Age also did not act every bit an effect modifier (all interaction terms p>0.xx; information not shown).

Discussion

Aides above the median age of 48 years had a reduced risk of verbal abuse, a finding also reported in some other HC study.21 A possible caption is that age is a proxy for job experience and that with experience comes better communication and coping skills. Additionally, our focus groups and some literature advise that older aides may be better able to empathize a customer's life experiences and thus may relate better to an older client'southward wellness and emotional needs.28 29

In the age-adapted model, two customer-related factors (dementia and lack of adequate piece of work space in a customer'southward home) were of import risk factors for verbal corruption while 1 work-organisational factor (an aide having predictable piece of work hours) was protective. In HC, anticipated hours reflect the time that an aide works and often a routine with known clients. Anticipated work hours may foster relationships in which clients and aides empathize each other'southward expectations. Routine and predictability with consistent staff may also reduce defoliation and irritability in HC clients; this consistency is already recommended for addressing challenging behaviours of patients with dementia in long-term care.34 Our formative phase study29 likewise plant that change is non easy for elders; the outset client visit is oftentimes the hardest for aides.

Our finding that dementia is an of import hazard factor for verbal abuse is consistent with findings in several studies of occupational violence against wellness workers.3 7 29 34 Nosotros besides found that a client's home with too niggling space for intendance work was an important run a risk factor. While we are not enlightened of previous findings of inadequate work space equally a factor in exact abuse, information technology is consistent with literature on the importance of other aspects of good workplace environmental design for violence prevention in healthcare and social services.4 35

There was suggestive evidence for two boosted run a risk factors, although their CIs included the zippo in the terminal age-adjusted model: clients with limited mobility and lack of clearly specified care plans. These findings are supported by previous research. For example, treatment and transfer tasks have been identified as risks for physical abuse in HC and nursing homes,7 36 and it may be that the condition of having limited mobility, beyond the specific deed of handling, is worth because to reduce exact corruption. Limited mobility represents a loss of independence and control, including greater dependence on assistance with intimate tasks, and relying on a HC adjutant for help in i'southward own dwelling house may compound these feelings.

It is reasonable to posit that lack of a clear care plan could lead to defoliation about roles and expectations, and be a source of tension and ultimately verbal corruption. Having a clearly specified, written care plan was identified in presurvey focus groups every bit beneficial to both aide and client prophylactic; however, the care plan can likewise be a point of tension betwixt aide and client when aides are asked to perform activities outside the care programme or when clients do not cooperate to accomplish prescribed activities.29

The results of these analyses suggest several pathways for verbal abuse intervention. Job orientation and ongoing grooming may be useful to address the challenges of working with clients with limited mobility and dementia.3 4 29 In Massachusetts, grooming requirements for agency-hired aides vary considerably from a few to 75 hours, depending on duties. Previous studies of HC in other states have plant that agency-provided violence training varies considerably.one 21 At the time of this survey, client-hired aides received very little preparation. However, since our survey, client-hired aides began receiving spousal relationship-negotiated job orientation including basic occupational safety. In our study'south formative stage, HC agency representatives reported that a customer intake evaluation—unremarkably carried out by a instance managing director—contributes to both worker and client safety. This cess is the foundation for care plan development and interventions to accost the chance factors identified in this study could be included in this plan.29

Limitations

Responses to the survey questions were self-reports. Healthcare workers contextualise abusive behaviours and may not consider them violence when attributed to causes such as client historic period or health conditions.37 To minimise potential under-reporting, the questionnaire presented descriptive questions of explicit actions nether the domain of 'client/family behaviour'; the words violence or abuse were not used, and no attribution of intent was implied. Additionally, these questions were a small part of a larger survey of a broad range of piece of work conditions among HC aides. For these reasons, information technology is unlikely that aides differed in willingness to complete the survey based on whether they experienced corruption.

Because reports of verbal abuse and working weather condition were collected at one point in fourth dimension, it cannot be adamant if risk factors preceded abuse. Also, the survey pattern gathered aide-level events like abuse 'in the past 12 months', while routine client and work organisation characteristics were gathered for specific visits inside the past month. While the 12-month recall period is a standard occupational health survey fourth dimension frame and was used in the US home health aide survey,32 call back of events may decrease with fourth dimension, particularly for less severe types of verbal corruption. If so, our findings of the occurrence of verbal corruption are likely underestimates.

In the HC industry overall, job turnover among HC aides is loftier, with contributing factors ranging from financial and personal stressors to emotional strain and injury.23 38 39 To the extent that abuse contributes to turnover, in that location may be selection bias in the aides who were still employed to receive this survey. Also, this study did not examine the link from incidence of abuse to harmful wellness outcomes. The measured event variable, designed to capture events, may not capture cognitive processing of those events which could either lead to, or protect from damage.22 40 The presence or absence of malice may touch on the psychosocial consequences of an action.xiii Thus, take chances factors for behaviours that aides believe are committed with malice may be different from those understood to occur without malice, and this written report could not business relationship for that. Additionally, considering abuse was operationalised as a binary variable, the frequency of different kinds of corruption was not compared. If some kinds of verbal abuse are more than harmful than others or if frequency is a factor in causing harm, this binary variable may not correspond the highest hazard. These limitations likely contribute to an underestimation of the bodily occurrence of exact abuse in our study population, however, the take a chance and protective factors we identified are not likely impacted.

The agencies participating in the survey were members of the Massachusetts trade association for HC services, and many member agencies actively back up worker safety and health; thus it is possible the agencies participating in this study were more than diligent regarding occupational health than agencies in other states. This could contribute to an underestimation of the gamble of verbal abuse. Since 2007, all publicly funded customer-hired aides in Massachusetts are organised past a single labour union. The client-hired aides in this study are representative of this larger population. At the time of this survey, training for client-hired aides was minimal and so they were similar to non-unionised aides in this regard. Notwithstanding, the union has after bargained successfully for worker rubber measures including training benefits and orientation.

Conclusions

This study found that verbal corruption is common among HC aides and is strongly associated with physical abuse. We identified verbal corruption risk factors for which preventive interventions tin can be implemented. While the study cannot testify that these factors are causal, all suggested interventions too have benefits for improved care quality and work weather condition beyond abuse prevention. Training on dementia can offer helpful work practice and communication strategies for aides. Initial and periodic client home assessments tin can include the conclusion of infinite requirements for intendance tasks and need for assistive devices to mobilise clients as well as evolution of care plans that consider the safety of both customer and adjutant. While providing aides with anticipated piece of work hours can be challenging to the HC manufacture, it may benefit clients and aides, and potentially assist address employee turnover, one of the manufacture's biggest challenges.

Acknowledgments

Natalie Brouillette, Daniel Okyere and Chuan Lord's day are gratefully acknowledged for their participation in the Safe Home Care Survey administration and data grooming. The Safe Home Care Project enquiry team members thank the habitation care aides and agencies, merchandise associations, labour unions, elderberry services professionals and other participants who contributed to this report. The authors would like to thank home intendance aides and other caregivers who enrich so many lives.

Footnotes

Contributors: NDK, PKM and MMQ conceived of the written report. PKM, DK, RJG, CJG, SRS and MMQ designed the questionnaire and collected the information. NDK conducted the statistical analyses with substantial contributions from DK, RJG and MMQ. NDK drafted the manuscript. All authors contributed to the interpretation of the findings and substantially commented on iterations of the manuscript. MMQ submitted the manuscript. All authors approved the final version.

Funding: This publication was supported by the US National Institute for Occupational Safety and Wellness (NIOSH)/Centers for Disease Control and Prevention (CDC) grant numbers R01OH008229 and T01OH008424.

Disclaimer: Its contents are solely the responsibility of the authors and do not necessarily correspond the official views of the Centers for Illness Control and Prevention or the Section of Wellness and Human Services.

Competing interests: None declared.

Ethics blessing: All methods and materials were approved by the Academy of Massachusetts Lowell Institutional Review Board, Protocol Number: ten–040-QUI-XPD.

Provenance and peer review: Not commissioned; externally peer reviewed.

Patient consent for publication: Non required.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585262/

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