Study finds home health aides struggle with mental health

Home health aides (HHAs) are vulnerable to stress, isolation and depressive symptoms, which impact their own health as well as their patients' desire to age in place, according to Weill Cornell Medicine researchers. HHAs are a rapidly growing workforce trained and certified to provide personal and medical care, as well as emotional support, in the home.

"As a doctor, I've learned that home health aides are a critical part of patients' well-being," said senior author Dr. Madeline Sterling, associate professor of medicine at Weill Cornell Medicine and a primary care physician at NewYork-Presbyterian/Weill Cornell Medical Center.

"Our study identified aspects of their job that affect their mood and stress levels, and suggested ways to address these challenges, including interventions that bring them closer to their colleagues."

As part of the study, published June 6 in JAMA Network Open, researchers interviewed 28 HHAs in New York City at risk of poor mental health. The study was conducted in collaboration with 1199SEIU Training and Employment Fund, a part of the 1199SEIU United Healthcare Workers East, the largest health care union in the United States.

The need for home health aides outstrips availability

Several themes emerged from the study including how interactions with patients and their families can affect aides' moods in both positive and negative ways. The researchers also explored the participants' attitudes toward mental health and well-being which can carry stigma due to personal and cultural factors.

While the aides reported having different coping mechanisms, many said they would welcome more support, including programs that bring them closer to their colleagues.

The need to address the emotional well-being of HHAs comes at a time of increased demand for their services.

"We have tsunami coming of people who will require care at home," said co-author, Faith Wiggins, director of long-term care at 1199SEIU Training and Employment Fund. In fact, a 2022 report from the American Association of Retired Persons (AARP) found 800,000 people on waiting lists for home care and waits often lasting years.

Dr. Sterling noted that HHAs are an "overlooked and undervalued but increasingly vital workforce." The Centers for Disease Control estimates that 73 million people in the United States will be 65 years or older by 2030, and the majority would like to age at home. Home health care also has the added benefit of lower cost than institutionalized care.

Previous research from Dr. Sterling, who is also the director of the Initiative on Home Care Work at Cornell's School of Industrial and Labor Relations, found that before COVID-19 more than a quarter of HHAs nationally had fair or poor general health, and a fifth had poor mental health. Post pandemic, their health has worsened according to studies by Dr. Sterling and Wiggins and others.

These professionals are paid hourly rates slightly above minimum wage with few benefits—under what can be difficult and isolating circumstances. "We need a way to repair those problems and retain their talent," said Wiggins.

The new study outlines ways to address the challenges faced by HHAs through improving salaries and benefits and interventions that support mental health. Organized peer coaching, for instance, could help train and support aides, and enhance workplace safety and healthy behavior. If issues related to mood and stress were incorporated into peer coaching, aides would benefit even further.

Acquiring coaching skills could also help provide a home health career ladder or pathway for aides to earn higher wages as health coaches.

The authors suggest additional research is needed to test and implement culturally and occupationally tailored interventions. "For our patients to do well," Dr. Sterling said, "we need to support this workforce."