8292578 The safe home care intervention study: coaching clients to protect their aides’ safety

<h3>Objective</h3> Home care (HC) aides experience numerous safety hazards while delivering health and personal care services in clients’ homes; many hazards also put clients at risk. We hypothesized that clients would improve safety conditions in their homes when coached by a nurse who conducts a HC needs assessment before aides are assigned to begin the care services. <h3>Material and Methods</h3> In partnership with HC employers, elder services agencies, a labor union, and aides, we developed home safety coaching methods and materials for nurses to use when they first assess clients for HC services. We evaluated the coaching intervention using a proof-of-concept, 2-arm intervention study design. During their patient intake assessment, nurses participating in the intervention arm used motivational interviewing, facilitated by a safety handbook and video, to coach clients on home safety improvements. Control arm nurses performed client intake assessments with no changes to usual practices. Intervention effectiveness was assessed by the nurses and independently by aides who began visiting clients’ homes after the intervention implementation; aides were not aware of the intervention status of their clients. Following the study, we conducted 6 interview sessions including 11 nurses to evaluate their experiences while applying the intervention materials. <h3>Results</h3> Three HC agencies and two elder services contributed 35 intervention and 23 control homes. Nurses coached 97% of the clients and reported that 94% were engaged; 63% of clients implemented improvements. Nurses’ and aides’ assessments were correlated; homes with clients reported by nurses as resistant to safety changes had higher aides’ hazard scores. Interviews results indicated that the coaching provided a useful, structured approach for nurses to introduce safety principles, including how clients can establish positive working relationships with aides. <h3>Conclusion</h3> This proof-of-concept intervention was effective, inexpensive and can be scaled up to evaluate in a larger population. <h3>Funding</h3> This study was funded by the U.S. National Institute for Occupational Safety and Health (NIOSH).