January 30, 2023
By Julie Greco, School of Industrial and Labor Relations
Rural health care workers face challenges tied primarily to travel, which exacerbates poor working conditions already prevalent in the home care industry, according to a new Cornell study.
The main challenge for rural health care workers is tied to commuting to and from clients, especially in upstate New York, where winter weather can make transportation between clients difficult, and sometimes impossible, according to the paper, “Making a Bad Situation Worse: Examining the Challenges Facing Rural Home Care Workers,” published online in the Journal of Applied Gerontology.
As the U.S. population ages, the demand rises for home care workers – direct caregivers who provide personal, medical and emotional care to clients with a range of health conditions. Despite their importance, these workers experience low compensation and inadequate training. They provide emotional labor that often goes unrecognized and uncompensated, and turnover is high.
“The main finding is really that distance and transportation is a problem in and of itself, but it also really exacerbates the poor working conditions prevalent in the home care sector more broadly,” said doctoral student Johnnie Kallas, who is the paper’s first author. “Policymakers need to understand and account for some of these unique challenges that rural caregivers face.”
According to Kallas, the low wages earned throughout the health care industry put those who work in rural locations in especially precarious positions because they need reliable personal transportation to travel long distances. When the transportation doesn’t work, neither can they.
The paper is part of Cornell multidisciplinary research aimed at elevating the value of home care work and was co-authored by ILR Professor Ariel Avgar, Ph.D. ‘08, Dr. Madeline Sterling ’08, assistant professor of medicine at Weill Cornell Medicine, and Nicola Dell, associate professor at the Jacobs Technion-Cornell Institute at Cornell Tech and in the Cornell Ann S. Bowers College of Computing and Information Science.
The researchers interviewed 23 participants who have experience providing home care in rural areas of upstate New York. Twenty-two of the 23 participants identified as women and 19 identified as white. In conversations, they expressed issues related to working in a rural community.
While the main issue proved to be transportation-related, many also reported difficulty in convincing clients to complete a required task on the care plan because of social norms in rural communities.
“For example, one aide spoke about clients having a ‘farming mentality,’” said Kallas, “meaning the clients were used to living on their own and providing for themselves. They’ve been doing it for decades, and so it can be difficult for the home care workers to get their clients to follow the care plan.”
Short visits are also a common problem in rural areas due to large distances and long travel times between clients. Many health care workers said they see the same client for no more than two hours per day multiple times each week, commuting long distances between several clients daily. These short visits impact the type of care received, as the worker is focused on completing all care plan tasks, leaving little time for some of the companionship and emotional support that are important, though invisible, components of home care.
Client resources also affect rural health care workers. Many clients rely on well water in rural areas, so poor water quality and limited availability can be challenges.
Finally, rural clients are particularly vulnerable to social isolation and loneliness, which leads some health care to provide companionship as an essential part of their work.
“One aide told us about how she had developed a really strong relationship with a client, and she knew that there was an incoming storm and that she might not be able to get to her house the next day. So she actually went to service her client for no pay the night before and then stayed over,” Kallas said. “That’s hours of unpaid labor that this person is doing just to make sure her client receives care because she knew that there was nobody else to do it.”
Additional authors include Olay Ajayi ’23 and Ethan Mulroy ’24, both in the ILR School, as well as Elizabeth Kuo, a research assistant at Cornell Tech, and doctoral student Joy Ming.
Julie Greco is a senior communication specialist for the ILR School.