The experiences of homecare workers in navigating the COVID-19 pandemic: a protocol for a qualitative study

Introduction

Increased life expectancy, multimorbidity and population growth have led to an increase in the number of people who require homecare assistance to meet their health needs (Martínez-Linares et al., 2020). The homecare sector is projected to grow significantly as society ages and care shifts from the acute care to the home environment (Leverton et al., 2021). As the demand on the homecare sector increases, the sector is increasingly under pressure to retain experienced staff, and frequent turnover can negatively impact on the quality, safety and continuity of care, particularly among vulnerable older adults (Burton et al., 2022; Yeh et al., 2019). The reasons for high turnover are multifactorial. Homecare workers are generally low paid, low status, have high staff turnover and are reliant on temporary or migrant staff, where training is not rewarded, mandatory or culturally valued (D’Astous et al., 2019; Vandrevala et al., 2016; Zeytinoglu & Denton, 2006). It has been known to be called a “diaphanous profession” or the “invisible welfare” due to the lack of recognition these workers receive for their job (Gazzaroli et al., 2020). In a recent study, Belgian homecare workers described feeling “squeezed like a lemon” due to the poor working conditions and the demanding nature of the job (Bensliman et al., 2021). In Norway, homecare workers reported being exposed to occupational hazards and physically demanding tasks which affected their safety, health and wellbeing (Gronoset Grasmo et al., 2021). In the UK, qualitative semi-structured interviews were held with 29 homecare workers providing care to people with dementia at end of life and 13 homecare managers. The homecare workers felt “emotionally drained, under-prepared and overwhelmed”. It was found that there is a need for development of models to support homecare workers and alleviate the emotional, interpersonal and practical burdens (Yeh et al., 2019, pp 352–359). A further UK study explored the training and support needs of homecare workers and reinforced the need for the development of a professional framework, incorporating training for homecare workers as well as ongoing practical and emotional support (Leverton et al., 2021).

In Ireland, a home support service is provided to older adults who wish to remain in their own home. This service was previously known as the Home Help Service or Home Care Package. The individuals caring for older adults are known as homecare workers, home carers, home help or home support (Home Support Services, 2022). In 2018, the Institute of Public Health in Ireland conducted a report to improve home care services in Ireland (The Institute of Public Health, 2018). This report highlighted that home carer workers are largely underpaid; employment is often insecure and opportunities for advancement are low. It was recommended that homecare be defined, and specific services should be addressed i.e., sociopsychological needs, loneliness, companionship and domestic services. In addition, it was recommended that a standardised policy framework may be important to implement, however, there must be scope for service flexibility.

Homecare workers have played a key role in supporting community dwelling older adults to live in their own homes and communities during the coronavirus disease 2019 (COVID-19) pandemic. The pandemic has led to 400 million reported cases and 6 million deaths globally (WHO, 2022). Unlike other health professionals, whose interactions with patients are relatively brief, homecare workers sometimes spend hours with clients assisting with caregiving and functional tasks. In addition, these workers frequently provide companionship and emotional support. The COVID-19 pandemic has resulted in many challenges to this caregiving role, given the risk of virus transmission to both clients and homecare workers in the community. A US study found the COVID-19 pandemic led to deterioration of clients’ health due to a lack of social supports compared to those available pre pandemic, with this paucity of support networks found to impact mental and physical health, particularly in the role of homecare workers (Bell et al., 2022). These findings echoed a study exploring COVID-19 challenges amongst home based palliative care workers, with staff driven to provide care throughout COVID-19 and its associated risks due to a strong sense of responsibility towards their clients and colleagues, identifying their role as one of the few stable supports for clients and families (Franchini et al., 2021). Insights for an EU study which explored homecare workers’ training and learning experiences during COVID-19 highlighted the challenges faced by staff, while also acknowledging homecare workers’ adaptability through the learning of new practices, skills and approaches (Malmgren Fänge et al., 2022).

Despite the recognition of higher mortality rates among older adults and higher overall rates of disease among nursing home staff, little remains known about the risks and experiences of workers who provide help and care to older adults who live at home (Allison et al., 2020; Weeks et al., 2021). The protocol for this qualitative study explores the experiences of homecare workers in navigating the COVID-19 pandemic.

Protocol

Data collection

Study researchers developed a semi-structured focus group guide which consists of three content areas: participants’ experiences of providing homecare since the COVID-19 outbreak, challenges participants have faced since the COVID-19 outbreak, what has supported participants since the COVID-19 outbreak. The focus group guide consists of open-ended questions and related prompts. The focus groups will take place in person in mid-June in 3 Clarecare bases – Killaloe, Kilkee and Ennis, over a period of 3 days. See extended data for the focus group guide (Moynan et al., 2022a).

Data analysis

Focus groups will be digitally audio-recorded, transcribed and exported to NVivo (Version 12.6.0). Each participant will get their own unique number. The participants’ details and their associated numbers will be kept on a password-protected Excel file. The transcribed focus group data will be analysed following a reflexive thematic approach (Braun & Clarke, 2021) through the identification and analysis of themes from the focus group data (Byrne, 2021). Initially a focus group transcript will be coded by two independent researchers (EM and CF) and subsequently discussed to explore different perspectives and insights from coders, as opposed to seeking consensus. All data will then be coded by one researcher. The six steps of thematic analysis described by Braun and Clarke will be followed (Braun & Clarke, 2021; Braun & Clarke, 2006), which will be used as a guide, with an emphasis on the flexible nature of these steps in line with the reflective thematic analysis approach utilised. The first step, involving data familiarisation, will be achieved through analysis following transcription and reading of all data. The second step, involving generating initial codes systematically across the data set, will have a particular focus on the research question. In the third step, overlapping codes will be identified and preliminary themes will be identified. In the fourth step, these themes will be reviewed with the research supervisor and in the fifth step they will be defined and named. The final step involving preparation of the manuscript with quotes from the focus group data will be completed to illustrate the themes identified.

Dissemination

Subsequent to the analysis stage, key themes and a summary of findings will be shared with participants. Abstracts will be submitted to relevant national and international conferences. Locally, the study results will be shared with management and staff at Clarecare.

Study status

Data collection is expected to take place mid-June 2022, with transcription of interviews and data analysis to be completed late June 2022.

Conclusion

To the authors’ knowledge, no studies have been conducted to explore the experiences and perspectives of homecare workers during the COVID-19 pandemic. It is anticipated that understanding and exploring their experiences will assist in the development of interventions that may serve to improve working conditions and supports for homecare workers.

Data availability