Understanding Home Care Aides’ Roles in Health Care for Older Adults

As Americans live longer, an increasing number experience limitations in daily activities, such as bathing, and reduced capacity, such as reduced joint flexibility. Older adults residing at home with these challenges often require support from various individuals, including home care aides (HCAs). Home care aides provide personal care (e.g., bathing) and housekeeping (e.g., laundry) and are not considered part of medical care. Mounting research demonstrates that HCAs encounter older adults’ medical problems and may have more extensive roles in older adults’ health than their job description entails. However, there is a lack of published research on their contributions to medical care. Enhancing our understanding of HCAs’ roles in relation to others working in the home may improve care quality and positive health outcomes. The purpose of this dissertation is to understand the critical yet often overlooked roles of HCAs in publicly funded home-based care for older adults with daily activity limitations, with a focus on HCAs’ contributions to older adults’ medical care. The dissertation addresses three key aims: how HCAs contribute to older adults’ medical care, how HCAs help adapt older adults’ home environments, and the convergent and discriminant validity of an ankle range of motion measure intended for use with older adults in home care settings. Using existing and newly collected qualitative data, we found that HCAs perform care functions that are part of older adults’ health care in that they maintain or improve health and well-being, but not entirely either custodial or medical care. Additionally, we used assessment and survey data collected as part of a larger study to establish the validity of a portable ankle range of motion measure designed for older adults with limitations in daily activities, who may not be able to stand. The measure can accurately identify reduced ankle range of motion in older adults, enabling HCAs and rehabilitation professionals to support strategies that enhance ankle range of motion and adapt the home environment accordingly. By centering HCAs’ perspectives, this dissertation generates new insights into HCAs’ roles in health care and opportunities for coordination and communication between HCAs and medical professionals.