Home health aides’ perceptions of quality care: Goals, challenges, and implications for a rapidly changing industry

Home care payment models, quality measures, and care plans are based on physical tasks workers perform, ignoring relational care that supports clients’ cognitive, emotional, and social well-being. As states seek to rein in costs and improve the efficiency and quality of care, they will need to consider how to measure and support relational care. In four focus groups (n=27) of unionized, agency-based New York City home health aides, workers reported aide–client relationships were a cornerstone of high-quality care, and building them required communication, respect, and going the extra mile. Since much of this care was invisible outside the worker–client relationship, aides received little supervisory support and felt excluded from the formal care team. Aligning payment models with quality requires understanding the full scope of services aides provide and a quality work environment that offers support and supervision, engages aides in patient care, and gives them a voice in policy decisions.