Home Health Aides Struggle with Mental Health, Seek Support

A new study by researchers at Weill Cornell Medicine has found that home health aides (HHAs) are vulnerable to poor mental health and stress, highlighting the need for interventions and support systems to bolster this crucial workforce.

The need for long-term care services is significant and expected to rise dramatically. According to the U.S. Department of Health and Human Services (HHS), around 56% of people reaching age 65 in the United States will require long-term services and supports (LTSS) at some point in their lives.

This LTSS can include home-based care or care provided in facilities. A report by the National Academies of Sciences, Engineering, and Medicine (NASEM) projects this number to grow to a staggering 15 million people by 2050, up from 6.3 million in 2015.

This increase is primarily due to the aging population and advances in medical science. The number of Americans over 85 is expected to more than triple by mid-century. As the demand for LTSS surges, the pressure on American families to pay for or provide long-term care increases.

Health insurance and Medicare only pay for short-term skilled care, leaving Long-Term Care Insurance for those who have policies in place or Medicaid, for those with limited financial resources, as the primary payers for long-term care services. This means that most long-term care is paid from an individual's income and savings, or provided by family members, or a combination of both.

Home Health Aides Feeling the Pressure

The study, published in JAMA Network Open, surveyed home health aides in New York City and found that many struggle with symptoms of depression, anxiety, and loneliness. The factors contributing to this mental health burden include:

• Demanding work environment: Long hours, low pay, and inadequate breaks were cited as stressors.
• Interpersonal challenges: Difficult patient relationships, including those with racist or discriminatory behavior, and unsupportive family dynamics were reported.
• Lack of agency support: Poor communication and inadequate patient information were identified as concerns.
• COVID-19 pandemic: The pandemic exacerbated existing stressors and added new ones, such as fear of contracting the virus and lack of personal protective equipment.

Ways to Cope

Despite these challenges, the study also found that home health aides use various coping mechanisms, including exercise, prayer, and compartmentalization. Notably, the study participants expressed a strong desire for additional support, including:

• Mental health education and resources
• Peer support programs
• Improved communication and information sharing from agencies

Lead author Melissa Yanez Hernandez, BS, says that these findings highlight the critical need to address the mental health of home health aides.

They are essential caregivers who play a vital role in allowing older adults to age at home. By providing them with the support they need, we can ensure they are better equipped to provide quality care and maintain their own well-being.

The study's senior author Dr. Madeline Sterling, MD, MPH, MS, is an associate professor of medicine at Weill Cornell Medicine and a primary care physician at New York-Presbyterian/Weill Cornell Medical Center, adds that mental health services will benefit the caregiver and the care recipient.

This research suggests that interventions and policies tailored to the unique challenges faced by home health aides are warranted. Investing in their mental health will not only benefit them but also improve patient care and the overall sustainability of the long-term care workforce.

Researchers note that the study was conducted in New York City and may not apply to home health aides in other locations. In addition, the research relied on self-reported data, which can be subject to bias.

Increasing Demand for Long-Term Care Increasing Costs

The Centers for Disease Control and Prevention (CDC) predicts a surge in America's older population, with an estimated 73 million reaching 65 or older by 2030. Many of these individuals prefer to age in their own homes, and home health care offers a cost-effective solution compared to traditional institutional care.

Long-term care costs are increasing rapidly nationwide, but the LTC NEWS Caregiver Directory notes that these costs vary widely depending on location.

• Cost of Long-Term Care Services Based on Location

Weill Cornell Medicine researchers say that the concern for the emotional well-being of home health aides comes at a time of increased demand for their services.

Faith Wiggins, the study's co-author and director of long-term care at 1199SEIU Training and Employment Fund, is well aware of the increasing demand for such services.

We have a tsunami coming of people who will require care at home.

A 2022 report from the American Association of Retired Persons (AARP) found that 800,000 people are on waiting lists for home care services, with waits often lasting years, highlighting the growing demand for home care and the challenges many face in accessing timely care.

Dr. Sterling says she has learned that home health aides are critical to patients' well-being. She noted that HHAs are an “overlooked and undervalued but increasingly vital workforce.

For our patients to do well we need to support this workforce.

Planning Reduces Family Stress

The research underscores the need for advanced planning for the consequences of aging. Families often find themselves in a crisis when a parent is in need of help with daily living activities or supervision due to memory loss.  

Understanding that unless you have limited financial resources, you should consider planning before retirement to address the costs and burdens of long-term care needs. For many families, the plan should include Long-Term Care Insurance.

"Long-term care planning is not just about protecting your assets; it's about ensuring that you have the freedom to choose the type of care you want, when you need it, without becoming a financial burden to your loved ones," - says Dr. Susan Reinhard, Senior Vice President and Director of the AARP Public Policy Institute.

Since the cost of an LTC policy is based on age and health when obtained, most people do so in their 40s or 50s, but for those with reasonably good health, good options are available in their 60s and beyond. An LTC Insurance specialist can match your age and health with the insurance companies that offer long-term care solutions.