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Home Care Workers: America's Tireless Travelers

~Patricia Kimball, Executive Director, Elder Abuse Institute of Maine

~Stuart Lewis, Associate Professor of Medicine, Geisel School of Medicine at Dartmouth College

~Zach Gassoumis, Assistant Professor of Family Medicine and Gerontology, University of Southern California

November was Home Care Worker month, and we want to recognize those workers in the U.S. who each year travel the equivalent of a trip to Pluto and back, going from home to home providing care, comfort and attention for older Americans. The hours are long, the work, physically and emotionally demanding, and under the shadow of COVID potentially life-threatening. Still they show up. If this wasn’t enough, Home Care Workers are also relied on to be an early warning system for elder abuse.

It’s believed that about one in ten Mainers over the age of 60 are abused or mistreated each year, and national studies suggest that this underestimates the true number.  What is clear is that most often the abuser is a family member, often a caregiver. 

Caregiving takes a toll on families. Research consistently demonstrates that caregiver burden is a predictor of elder abuse and social connectedness a protection. Without help from professional home care workers, families—usually adult daughters or spouses—struggle to help their older loved ones stay in their homes as they age.  Maine’s workforce shortage means thousands of hours per month of home care needs are going unmet, so the risks to older Mainers are increasing daily.  

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The solution to elder abuse has historically relied on getting more people to report a concern to their state’s Adult Protective Services program, or APS. In Maine, APS is the agency responsible for investigating allegations of abuse, neglect, and exploitation of older and dependent adults, and for linking victims to community services and resources that will help keep them safe in their own homes. In almost all states, APS takes an ‘if you see something, say something’ approach, amended to “if you see something, you MUST say something” for certain professionals. Still, despite more and more people being added to the mandated reporter list—those persons who by law MUST say something- too much abuse remains invisible. Only about one in twenty older adults who are abused come to the attention of the authorities.  

We’ve been interested in this problem for years and know first-hand that calling APS is hard. Each of us has wrestled with that decision despite being ‘experts’ and mandated reporters ourselves. Are we sure it’s abuse?  What will APS be able to do? Will the person we are worried about even accept help? When they are friends or colleagues or patients, will our relationship be forever harmed by calling? 

Imagine what Home Care Workers face. We know mandated reporter laws increase the number of reports, but from data collected each year by Maine’s Adult Protective Services, calls from home care workers make up only a small fraction.  Many fewer than what would be expected, and no one knows why. As the only non-family connection to the outside world, are they concerned that reporting will lead to further isolation and risk to the vulnerable adult? Are they afraid they might lose their job? Does the trauma of witnessing their client’s suffering create a silencing in them? 

“If you see something, say something” is a great watchword, but the reality of getting someone to intervene is challenging. How do we empower people to believe that what they say matters? 

This is what we are trying to do with a new service in Maine – A Helping Voice

A Helping Voice is a safe, anonymous community where Home Care Workers (or any mandated reporter) can call for clarity, guidance and support in reporting elder abuse. It’s not for emergencies or part of any state agency. A Helping Voice is funded by the Robert Wood Johnson Foundation’s Interdisciplinary Research Leaders program, and was developed in partnership with and with guidance from many members of Maine's home care workforce who are as interested in solving this problem as we are.  All of us are hoping to reduce the barriers to reporting we know exist and listen closely to learn about others that we can address. 

As Mainers live longer our reliance on and need for Home Care Workers will only become more urgent. If we are all going to age better and safer we need to start recognizing the people who do and will care for us. Today, let’s be thankful for those tireless travelers who are the life bridge for so many Mainers. 

Project Team:

Patricia Kimball, Executive Director, Elder Abuse Institute of Maine 

(207-449-8805)

Stuart Lewis, Associate Professor of Medicine, Geisel School of Medicine at Dartmouth 

(917-822-2035)

Zach Gassoumis, Assistant Professor of Family Medicine & Gerontology, University of Southern California

(925-708-5143)