Exploring Strategies to Improve Turnover Staffing Shortages and Support for In-Home Family Caregivers

Home care workers play a vital role in supporting older adults, yet retaining staff in these positions can often be challenging.The purpose and review question for this integrative review concerned the strategies and best practices for home health agencies to retain formal caregivers and implement in-home/informal caregiving as an integral component of the caregiving team.Penchansky and Thomas's theory of access supported this study by highlighting how the qualities and expectations of home care workers align with their patients.A comprehensive review of the literature resulted in 53 articles, which were screened for quality and relevance.Of these, 24 studies were selected for further analysis using the Johns Hopkins evidence-based practice model.A comprehensive thematic analysis identified seven main themes and seven supporting subthemes.The seven main themes identified the need to increase patient satisfaction, strengthen agency staffing, improve human resources, reinforce employee training, develop education programs, increase compensation and benefits, and explore reimbursement improvements.Key subthemes emphasized adopting a patient-first approach in home care, combining courses and fieldwork experience, and partnering with colleges and universities.Three recommendations provided ways to strengthen home care services by creating a fund for home care workers' incidental expenses, leadership training, and promoting new career advancement opportunities for home care workers.By following these recommendations, home and community-based services can create an encouraging environment for both agency-based and in-home care workers.This approach may improve patient care and promote positive social change within communities.regarding the turnover staffing shortages of caregivers within home healthcare agencies, and the lack of support for in-home/informal caregivers, because, as the population ages, the lack of access to HCBS is a serious social problem that is usually addressed through home healthcare agencies.However, HCBS is now mostly provided by in-home/informal family caregivers who suffer stress, depression, sleep deprivation, and anxiety due to burnout, which is a serious social problem for aging-in-place older adult vulnerable populations and their families that needs to be addressed immediately.Penchansky and Thomas (1981) defined access as: "The degree of fit between the consumer and the service; the better the fit, the better the access."Ha (2024), like Saurman (2016), posited that awareness is more than simply having knowledge that a product or service exists.Rather, awareness is also comprehending the purpose of that product or service, its application, for whom it was conceived, designed, and created, as well as why.These authors pointed out that access is dependent upon the fit between the service and the end user, in other words, the fit of all the dimensions of the service, such as accessibility, availability, acceptability, affordability, adequacy in service design, and implementation and evaluation.For instance, the turnover staffing shortage in HHCA caregivers and the lack of support and training for in-home/informal family caregivers to provide HCBS as a much-needed essential service for aging-in-place older adults exercising their option to be cared for and medically followed from within their own homes and communities; in other words, HCBS is a good fit in the services of aging-inplace older adult vulnerable populations to a much higher degree.