Date of Award

May 2017

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Social Sciences


Janet M. Wilmoth


home health care, long-term care, occupational health, occupational stress, work-related stress

Subject Categories

Social and Behavioral Sciences


Home health care workers fill an essential role in the daily lives of elderly persons. However, the work is physically and emotionally exhausting. This mixed-methods study explicates sources of stress found in agency-based caregiving in the post-industrial economy. Agencies operate under a highly regulated legal and organizational framework, but little is known about how to reduce sources of job strain to better protect workers’ health. Drawing on existing occupational health stress theories (Karasek; Siegrist; Landsbergis) and sociological stress theory (Pearlin; Fenwick & Tausig), this study explores how workers’ experiences and agency characteristics are related to home health care worker’s occupational health and self-rated health.

Multinomial logistic regression models estimate the health impacts of occupational stressors among home health care workers using data from the CDC’s National Home Health Aide Survey (n=3,235). Qualitative analysis feature the analysis of both agency executives’ and home health care workers’ narratives (n=45) from nine upstate New York home care agencies. By interrogating upper and mid-level management in addition to the workers, the agency’s inner workings were made more transparent.

Detailed results upheld Demand/Control/Support and Effort-Reward Imbalance theories while also demonstrating that discrimination on the job and double burden care routines are negatively associated with health. Unexpectedly, blacks were less likely to report injuries than whites. The finding suggests black are under-reporting and may be at risk for occupational health inequality because they are not accessing workers’ compensation. Aides report financial strain, exposure to poor working conditions and lack of respect on the job as centrally important. Agency leaders’ responses vary, but generally concede that high-level stressors “trickle down” and can become work-related stressors for home health aides. Lack of training and low-quality training are also implicated in impeding progress in addressing home care workers’ health.

Demand for home health care workers is urgent as the baby boomers age into later life. Policy work in a changing health care system requires coordination at the federal, state, and agency levels to achieve appropriate compensation, updated training, greater access to occupational health care and healthier work conditions - leading to improvement in the quality of home-based long-term care.


Open Access