The effects of occupational stress on the health of marginalized care workers

Occupational Stress In Marginalized Care Workers And The Implications For Societal Health

As more people choose to age in place, the need for home care aides is expected to increase by more than 30% over the next decade, making it one of the fastest expanding jobs in the country.

Despite the demand, historically low wages and terrible working conditions have made it impossible to attract and retain these critical workers, a situation exacerbated by the COVID-19 pandemic.

Over the last two years, CUNY SPH Associate Professor Emma Tsui and colleagues have conducted a series of studies to better understand occupational stress among home health aides, particularly around patient death, and its impact on worker well-being and employee retention, resulting in five recently published articles.

Professor Tsui notes, “It is generally recognized that home health aides frequently build strong ties with their patients, which helps patient care.”

“We discovered that aides frequently play a significant role in a patient’s end-of-life care, providing both practical and existential support, but often without being adequately informed about their patient’s health status or robustly trained for the emotional labor that comes with the end of life.”

Improved aide training on end-of-life concerns, supervisor training for supporting aides, and dedicated paid time off following client death, according to the team’s findings, could significantly reduce aides’ work stress connected to client death.

Without extensive training or more formal company-based assistance, aides rely on their personal networks or an informal combination of workplace and community-based help to cope with the sadness of losing their patients—and the resulting job uncertainty.

“Agencies that hire home health aides acknowledge the need for support, but they have difficulty operationalizing it,” says Tsui.

“We looked at one promising intervention in the form of group support calls at a NYC agency that arose during the COVID-19 pandemic, but given the current limitations of agency support and the fact that aides are often from already burdened communities, our research highlights the importance of comprehensive policy and community-based support solutions alongside job-based support.”

“Expanding the Conceptualization of Support in Low-Wage Carework: The Case of Home Care Aides and Client Death” was published in December 2021 in International Journal of Environmental Research and Public Health, Supplement: Work, Health, and Equity; “We want to hear your problems and fix them: A Case Study of Pandemic Support Calls for Home Health Aides” was published in February 2022 in Home Care Services Quarterly; and “Awareness, Acceptance, and Adaptation: A Case Study of Home

Professor Tsui and her colleagues recently published a commentary in New Solutions calling for a new model of societal health that recognizes all types of caregivers, as well as an invited editorial in the American Journal of Public Health highlighting important directions for public health research on worker well-being.

Sherry Baron, an affiliated CUNY SPH faculty member, Professor at Queens College, and project mentor, states, “Home care aides—whose work has historically had such little visibility—are vital to society health at large.” “The urgency of reevaluating the sustainability of our current care systems, reimagining care systems, and supporting the critical labor of home care aides is underscored by this range of study.”