Strengthening the Home Care Profession: Findings from an Evaluation of a Workforce Initiative in Richmond, VA
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Strengthening the Home Care Profession
Related Research
A three-year pilot project funded by the Richmond Memorial Health Foundation and the Bob and Anna Lou Schaberg Foundation aimed to enhance compensation, training, and transportation for home care aides working in two Richmond-based home care agencies.
Key Takeaways
An evaluation of the initiative, conducted by the LeadingAge LTSS Center @UMass Boston, found that the participating agencies were already performing well before the intervention. As a result, there was little change in job satisfaction or retention among home care aides after the intervention. While wage increases were valued by home care aides in the study, aides reported that these increases were insufficient to meet their financial needs.
Aides participating in surveys and focus groups expressed their appreciation for the initiative’s training and transportation support. However, they also highlighted several ongoing challenges, including low wages, travel difficulties, limited paid time off, gaps in onboarding, and a lack of information about clients.
This evaluation recommended the need for home care agencies to implement:
• Stronger onboarding.
• Improved communication.
• Targeted hiring.
• Ongoing training.
• Family education.
• Supervisor check-ins.
• Enhanced transportation benefits.
• Tangible recognition of aides.
Background
In 2023, two home care agencies in Richmond, VA, received a three-year grant from the Richmond Memorial Health Foundation to help them strengthen the home care sector by recognizing the value of home care aides and boosting their retention rates.
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Through two pilot programs, carried out separately at the two home care agencies, three interventions were implemented:
- Pay increases for home care aides.
- High-quality training for aides to build their skills and knowledge.
- A dependable backup transportation system provided through a partnership with Lyft, the on-demand ride-sharing service.
The LeadingAge LTSS Center @UMass Boston conducted an independent evaluation of the Richmond initiative.
Methods: Surveys and Focus Groups
Researchers conducted surveys and focus groups with home care aides to evaluate the impact of the Richmond initiative and to gain a better understanding of the work performed by home care aides at the two participating agencies.
Baseline surveys were conducted at each agency before the first wage increase. A second survey was administered at each agency following the implementation of two subsequent wage increases.
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The initial survey questions examined aides’ financial stability and job satisfaction, as well as their sense of empowerment, opinions on communication and training within their agency, and the transportation challenges they faced. The post-surveys included questions from the initial survey and explored aides’ perceptions of the wage increases, training, and transportation support provided during the intervention.
Two focus group sessions were held with aides at each agency to supplement survey findings with a more in-depth understanding of aides’ work experiences. These groups discussed the following topics:
- Motivation of aides working in home care.
- Aides’ experiences working at their agency and in clients’ homes.
- Perceived training needs.
- Transportation barriers.
- Level of on-the-job supervision.
- Perceptions of agency support.
- Challenges faced at work and at home.
- Recommendations for enhancing job quality.
Key Findings
Impact of the Initiative
Worker Outcomes
Surveys revealed that both agencies were already functioning effectively before the intervention commenced. As a result, no significant changes were observed in aides’ sense of empowerment, job satisfaction, views of the agency, or retention after the intervention.
Training
Training sessions were well-received and provided aides with practical strategies to enhance client care.
Transportation Support
Aides often used Lyft, the on-demand ride-sharing service, as a backup transportation option. The availability of transportation helped reduce work-related stress and logistical challenges for aides.
Wages
Aides valued the wage increases they received during the pilot projects. However, most aides still faced financial strain, and some found it necessary to hold multiple jobs to cover basic needs.
Recruitment of Aides
Following the intervention, one agency experienced an increase in its average hiring rate over both the six-month and 12-month periods. The agency also saw an increase in the average number of active employees and aides. However, despite these gains, the average number of hours worked per aide decreased following the wage increase, which was an unexpected outcome.
Challenges Facing Home Care Aides
The surveys and focus groups uncovered several challenges currently faced by home care aides. Researchers pinpointed these key issues:
Insufficient Compensation
Wages are too low to meet the basic needs of aides. Additionally, aides receive inadequate paid time off.
Transportation Barriers
Aides struggle with long travel distances, inconvenient or unavailable bus routes, multiple bus transfers, and high fuel costs. Transportation concerns can affect whether an aide accepts a new client.
Inadequate Onboarding
Some aides reported that the onboarding process is not comprehensive. Aides often do not feel prepared when visiting a new client because they receive limited information in advance about the client’s care needs and home environment.
Misunderstandings with Family Members
Family members may misunderstand the aide’s scope of work or the client’s physical and cognitive decline. Aides are sometimes faced with the challenge of setting realistic expectations and boundaries with family members.
Care Setting Challenges
Aides face difficulties while supporting clients living in assisted living communities. The caregivers working in these communities are often unable to provide timely help or fail to complete tasks.
Gaps Between Client Visits
Scheduling issues—particularly long waits between when one client stops or no longer needs services and when another one is added to the care schedule—caused financial difficulties for aides.
Recommendations to Improve the Home Care Work Experience
The following recommendations for improving the home care work experience emerged during focus groups:
Hire for fit and motivation.
Strengthen hiring practices to identify aides who are genuinely committed to their role and are motivated to help others, rather than just seeking a paycheck.
Enhance onboarding.
Develop thorough onboarding programs that feature mentorship and job shadowing.
Scheduling.
Track and analyze time gaps between the loss of a client and the reassignment of an aide to a new client to mitigate delays in care and financial stress among aides.
Improve communication and foster inclusion.
Ensure supervisors follow up after aides report concerns or issues. Involve aides in decisions that impact their work. Make sure aides have the most up-to-date information about a client’s condition and care plan.
Create detailed client profiles.
Ensure that aides have comprehensive information about new clients, including their care needs, behavioral issues, and household environment. Notify clients in advance about an aide’s visits.
Improve transportation assistance.
Offer ongoing subsidies or a formal benefit for mileage reimbursement or Lyft-like emergency backup options.
Encourage peer support.
Provide opportunities for aides to build camaraderie and share challenges and strategies. This is especially important for new hires.
Provide practical training.
Offer aides competency-based instruction tailored to their needs and challenges. Deliver both in-person and virtual training to accommodate various learning styles and schedules.
Educate the client’s family members.
Set realistic expectations and reduce conflict by providing families with clear guidance on the home care aide’s role and boundaries.
Schedule supervisor check-ins.
Arrange regular meetings between supervisors and aides to discuss client care, skill development, and the aide’s well-being.
Show genuine appreciation of aides.
Offer tangible rewards, such as gift cards, gas cards, or small bonuses.
Support career growth.
Provide tuition assistance or training to aides who are interested in specialty areas or seeking advancement within the field.
About the Project Partners
Richmond Memorial Health Foundation
The Richmond Memorial Health Foundation (RMHF) is a grantmaking organization dedicated to improving the health and well-being of the Richmond, VA, community, with a particular focus on racial equity. While initially formed from the assets of the former Richmond Memorial Hospital, the foundation has evolved beyond its traditional healthcare focus to address the social determinants of health through investments in the arts and grassroots community efforts. The foundation carries out this mission by prioritizing funding for organizations led by people of color, providing racial equity training, and creating specific initiatives to build capacity within grassroots organizations and develop local leadership.
For more information, visit rmhfoundation.org.
The Bob and Anna Lou Schaberg Foundation
The Bob and Anna Lou Schaberg Foundation envisions a community where vulnerable populations have opportunities—including equitable access to housing, essential services, and employment—to lead dignified, purposeful lives. At its core, the foundation’s mission is to “enable all populations to thrive.” It fulfills this mission by investing in nonprofits and initiatives that build capacity, foster collaboration, and address systemic needs across housing, workforce development, education, refugee support, elder services, and more.
For more information, visit Schaberg.Foundation.
LTSS Center
The LeadingAge LTSS Center @UMass Boston conducts research to help our nation address the challenges and seize the opportunities associated with an aging population. LeadingAge and the University of Massachusetts Boston established the LTSS Center in 2017. We strive to conduct studies and evaluations that will serve as a foundation for government and provider action to improve quality of care and quality of life for the most vulnerable older Americans. The LTSS Center maintains offices in Washington, DC, and Boston, MA.
For more information, continue exploring LTSSCenter.org.
Contributors
Natasha Bryant
Senior Director of Workforce Research & Development at the LeadingAge LTSS Center @UMass Boston
