title: Mental and behavioral health conditions among older adults: implications for the home care workforce.
abstract: The shift towards home and community-based care, coupled with the growing prevalence of mental and behavioral health conditions, increases the demand for skilled home care workers. However, little is known about the experiences of home care aides who provide care to clients with mental and behavioral health diagnoses. The purpose of this study was to identify challenges aides face in providing care to this particular group of clients, as well as the strategies and support they utilize to complete their job responsibilities.
  
  
  
  Data from five focus groups with home care workers (N = 49) throughout Massachusetts were used to examine the experiences of home care workers providing services to adults with mental or behavioral health needs. A constant comparative method was used during analysis of the focus group transcripts.
  
  
  
  Aides described a lack of prior-knowledge of challenging client behaviors, leaving them unprepared to deal with disruptions to care delivery. Aides feel unsafe or unsure providing care to someone with complex needs, made worse by a perceived lack of training and support from the broader care team. Aides develop unique strategies for accomplishing their work.
  
  
  
  This analysis of the aide's perspective contributes valuable, and often unheard, insight to inform what we know about providing reliable, quality and safe home care to this growing group of vulnerable adults. Implications of this convergence are discussed relative to aides.
authors.affiliation: a Department of Gerontology , University of Massachusetts Boston , Boston , MA, USA.
authors.forename: Hayley P
authors.initials: HP
authors.lastname: Gleason
authors.affiliation: b Department of Health Policy & Management, School of Public Health , Yale University , New Haven , CT, USA.
authors.forename: Caitlin E
authors.initials: CE
authors.lastname: Coyle
mesh_terms: D000368:Aged; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D018576:Home Health Aides; D006801:Humans; D008297:Male; D008404:Massachusetts; D008603:Mental Health
keywords: behavioral health; direct care workforce; home health aides; long-term care; mental health