Many of the 6.2 million American adults suffering from heart failure rely on paid caregivers for support, ranging from blood pressure checks and meal preparation to help recognizing and managing symptoms. Yet formal training on heart failure for home care workers is not currently widespread, formalized or required.
New cross-campus research from Weill Cornell Medicine and the ILR School shows that home care workers who have been trained in heart failure are more satisfied with their jobs and feel more prepared and confident working with heart failure patients.
Providing training in specific diseases, the research suggests, could improve home care workers' job satisfaction and their standing as valued members of health care teams.
"These workers are on the front lines with patients, and there are a lot of ways in which they can enhance patient care," said Ariel Avgar, Ph.D. '08, associate dean for outreach and associate professor at the ILR School. "With proper training and with a shift in the way care teams operate, this workforce could be leveraged more fully."
Avgar is a co-author of "Heart Failure Training and Job Satisfaction: A Survey of Home Care Workers Caring for Adults with Heart Failure in New York City," published in a special issue of Ethnicity and Disease this fall that highlighted research focusing on health equity.
Weill Cornell Medicine contributors included lead author Dr. Madeline Sterling '08, M.Sc. '18, assistant professor of medicine, as well as data analyst Joanna Bryan Ringel and research assistant Jacklyn Cho '19. Avgar and Sterling are both members of the Cornell Center for Health Equity.
The researchers surveyed 323 home care workers - a field that includes home health aides, home health attendants and personal care aides - about their training, job satisfaction and care of heart failure patients.
To conduct the survey, the team partnered with 1199 Service Employees International Union United Healthcare Workers East, which represents 75,000 home care workers employed by 55 agencies in New York City, and whose Home Care Industry Education Fund provides education and training. The researchers also partnered with a few private agencies in the city.
Roughly two-thirds of the workers reported having received "none" or "a little" training in heart failure. Among the third that had received "some" or "a lot," job satisfaction was 14% higher. Those workers also were more likely to feel prepared to help heart failure patients, to feel they were contributing adequately to the maintenance and management of their care, and to feel confident in their work.
For example, nearly 72% of home care workers who had received at least some heart failure training felt confident providing that care, compared with 30 percent of those lacking training.
Although job satisfaction was relatively high among home care workers overall, the higher levels among those trained in heart failure is significant, Avgar said, in a fast-growing sector known for low wages, challenging work conditions and high levels of burnout.
"Finding mechanisms through which to enhance home care workers' job satisfaction is a beneficial outcome in its own right," he said. "And then there's lots of reasons to believe that a more satisfied workforce dealing with heart failure patients is also likely to provide better care."
Home care workers receive general training and must pass exams as part of their certification, and also complete annual in-service training.
"This study is important because it demonstrates that investing in disease-specific training among home care workers - for example, in cardiovascular disease - may be a way to improve their experience caring for patients," Sterling said. "These findings support the need for additional training requirements for those home care workers caring for patients with complex clinical conditions, like heart failure."
The researchers speculated that disease-specific training might improve home care workers' job satisfaction by increasing their knowledge and sense of competence. It could also empower and build respect for a predominately female, minority workforce often overlooked by other medical professionals.
"They have much more of an opportunity to make a difference in the day-to-day routines of these patients and to be aware of symptoms that might be troubling," Avgar said. "To do that to the fullest extent, they need to be trained and to be seen by the health care system as agents of this kind of care."
Added Sterling: "Beyond our findings pertaining to job satisfaction, future studies should test whether heart failure training among workers improves the quality of care patients receive, as well as patient outcomes, two conceptions that we were unable to examine in this study."
The research was funded in part through a donation from Douglas Wigdor and supported by grants from the National Heart, Lung, and Blood Institute and the Robert Wood Johnson Foundation.
