Home Health Aides Feel Like ‘Replaceable Parts,’ Lack Agency Emotional Support

Efforts to recruit and retain home health workers typically focus on improving their economic and physical well-being, such as through wage increases, safety training or medical benefits. Although these retention strategies are important, they fail to address the “emotional labor” toll on workers, which regularly leads to burnout and a negative impact on a provider’s bottom line.

How home health agencies handle the emotional well-being of their aides—and how they can boost their retention efforts—was highlighted last week in a new study appearing in the journal The Gerontologist.

“We know there’s a large emotional component to any type of care,” Emily Franzosa, lead author of the study and a former researcher at the City University of New York’s Graduate School of Public Health and Health Policy, told Home Health Care News. “A lot of folks in our field say, ‘You can’t care without caring,’ but that’s often not reflected in training and compensation workers get.”


Findings from the study were drawn from a series of focus group interviews and follow-up discussions with unionized, New York City area home health aides who primarily serviced Medicaid-qualified clients. Participants belonged to 1199SEIU United Healthcare Workers East, which represents about 65,000 of New York City’s 158,000 home health aides, home attendants and housekeepers.

The vast majority of participants in the study were women, while 78% were foreign-born workers. More than half of participants in the study had been aides for more than three years, with many having worked both skilled and non-skilled positions.

“An enormous part of the work that aides are doing is emotional, but they’re not trained or prepared to deliver that kind of care,” Franzosa said. “It’s not part of training, job descriptions or compensation, meaning aides are really figuring out how to do this work on their own.”


Key takeaways

Overall, those who participated in the study said their relationships with agency supervisors were largely unsupportive and riddled by a pervasive lack of respect. Aides’ general consensus, in fact, was that agencies “don’t care about [them]” and that they “don’t appreciate what [workers] do.”

Indeed, many aides said that they felt their agency viewed them as replaceable parts whose sole purpose was to fill shifts, according to the study.

“Aides told us that they were not getting a whole lot of support,” Franzosa said. “They often felt that they were sort of seen as interchangeable bodies, that frontline supervisors were just trying to fill shifts and not really thinking about them as individual workers with individual clients.”

Lack of emotional support included not being available via phone when aides had issues with clients. It also included not being thanked when workers went above-and-beyond their duties to care for, say, a difficult client.

“In this environment, aides and frontline managers are under a lot of pressure to do more with less,” Franzosa said. “We know there’s a lot of pressure on those supervisors as well.”

Home health aides who participated in the study felt noticeably unsupported by their agencies in regard to clients passing away.

“That came through loud and clear with a lot of the aides,” Franzosa said.

Across industries, poor worker well-being is connected to depression, burnout, stress and exhaustion, all of which cause workers to become withdrawn and less engaged in their jobs, according to the study.

Besides the agencies that they work for, participants in the study said their emotional well-being is likewise influenced by their relationships with clients and clients’ family members.

Takeaways for home health agencies

When workers’ well-being is supported, they’re more likely to flourish in their roles and be more productive on and off the job. That’s a point home health agencies need to remember, Franzosa said, especially as funding becomes more closely tied to value, quality of care and patient satisfaction.

“I think this industry is in such a time of change and growth that these are things employers have to focus on—or they’re not going to have a workforce or be able to deliver high quality care,” she said. “The cost of turnover, too, versus being able to keep skilled, qualified workers in the industry is tremendous.”

The direct cost of employee turnover in the home care industry has been estimated to be about $3,500 per worker, past research has found. Some studies, though, have placed that estimated much higher.

Fortunately, there are several tangible steps agencies can take to boost their emotional support for workers, according to the survey.

For example, participants in the survey said that a dedicated hotline with someone who will listen would help aides cope with the emotional demands that come with their roles. Along those same lines, participants reported that open, responsive communication across the care team would also help.

Written by Robert Holly