Home Care for Elderly or Disabled Individuals
Conditions
Brief summary
This trial investigates whether high-quality training for consumer-directed home health workers impacts health outcomes for care consumers and employment outcomes for care workers. The investigators are conducting this study in the context of the In-Home Supportive Services (IHSS) program, a consumer-directed, Medicaid-funded home care program in California serving elderly and disabled Medicaid recipients. The investigators will partner with the Center for Caregiver Advancement (CCA), a training provider based in California, to conduct a randomized evaluation of the impact of training for IHSS workers on labor and health care outcomes. The evaluation will enroll IHSS workers in San Bernardino County, where CCA will be expanding its program. Participants will be randomized to either a group that receives CCA's training or a control group that does not receive training. Participants randomized to the training group will complete a 30 hour online course that teaches fundamental caregiving skills. Training includes personal care, infection control, nutrition and body mechanics, medication adherence, and home safety. Researchers will compare outcomes between IHSS providers in the two groups and between IHSS consumers who receive care from the IHSS providers in the two groups to see if training impacts health, health care, and labor market outcomes.
Interventions
OTHERIHSS Basic Training
The intervention is the Center for Caregiver Advancements 30-hour IHSS Basic training course.
Sponsors
Center for Caregiver Advancement
Massachusetts Institute of Technology
University of Chicago
Abdul Latif Jameel Poverty Action Lab
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Current IHSS provider * Live in San Bernardino County * IHSS consumer lives in San Bernardino County
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Number of emergency department visits (for consumer) | 1 year after training begins |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total length of stay in nursing facilities (for consumer) | 1 year after training begins | The number of days spent per consumer in a skilled nursing facility, rehab, or long term care facility during the year after training begins. |
| IHSS earnings (for provider) | 1 year after training begins | IHSS earnings for providers, measured weekly, quarterly, and annually, drawn from IHSS payroll data |
| IHSS hours worked (for provider) | 1 year after training begins | IHSS hours worked for providers, measured weekly, quarterly, and annually, drawn from IHSS payroll data |
| Any emergency department visits (for consumer) | 1 year after training begins | — |
| Estimated annual health care spending (for consumer) | 1 year after training begins | Estimated annual health care spending will be calculated by multiplying the number of inpatient admissions, emergency department visits, outpatient office visits, long term care stays, and prescription drugs by estimated average costs for those services among low income publicly insured adults. |
| Share of participants with falls resulting in a health care visit (for consumer) | 1 year after training begins | The share of consumers with falls will be measured using diagnosis codes from medical claims |
| Share of participants with urinary tract infections resulting in a health care visit (for consumer) | 1 year after training begins | The share of consumers with urinary tract infections will be measured using diagnosis codes from medical claims |
| Share of participants with pressure ulcers resulting in a health care visit (for consumer) | 1 year after training begins | The share of consumers with pressure ulcers will be measured using diagnosis codes from medical claims |
| Share of participants with nursing facility utilization (for consumer) | 1 year after training begins | The share of consumers who have a stay in a skilled nursing facility, rehab, or long term care facility during the year after training begins. |
| Share of participants still employed in IHSS (for provider) | 1 year after training begins | The share of IHSS provider participants who remain as workers in the IHSS program 1 year after the start of training. |
| Caregiving knowledge (for provider) | 0-3 months after completion of training | Proportion of correct answers out of 18 true false knowledge questions |
Other
| Measure | Time frame | Description |
|---|---|---|
| Number of hospital admissions (for consumer) | 1 year after training begins | — |
| Depression (for provider) | 0-3 months after completion of training | Patient Health Questionnaire-2 (PHQ-2). Scores range from 0 to 6, with higher values indicating worse outcomes. A score of 3 or higher identifies possible cases of major depressive disorder. |
| Anxiety (for provider) | 0-3 months after completion of training | Generalized Anxiety Disorder 2-item (GAD-2). Scores range from 0 to 6, with higher values indicating worse outcomes. A score of 3 or higher identifies possible cases of generalized anxiety disorder. |
| Caregiver wellbeing (for provider) | 0-3 months after completion of training | 18 question caregiver self assessment questionnaire developed by the American Medical Association (https://www.healthinaging.org/tools-and-tips/caregiver-self-assessment-questionnaire). Includes 16 Yes/No questions and 2 scale of 1 to 10 questions, with higher values indicating worse outcomes. 10 or more yes answers, having crying spells, feeling completely overwhelmed, a stress rating of \>=6 out of 10, or health rating of \>= 6 out of 10 all indicate distress. |
| Caregiver job satisfaction (for provider) | 0-3 months after completion of training | Self-reported answer to Overall, how satisfied are you with your IHSS job? on a 5-point Likert scale from very dissatisfied to very satisfied |
| Number of consumers served (for provider) | 1 year after training begins | How many people the provider is paid to care for as part of the IHSS program |
| Total length of stay in hospital (for consumer) | 1 year after training begins | — |
| Any hospital admissions (for consumer) | 1 year after training begins | — |
Countries
United States
Contacts
Primary ContactJesse Gubb, Research Manager, PhD
Outcome results
None listed