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APHA Scientific Session and Event Listing

Linda Delp, MPH, Labor Occupational Safety & Health Program, University of California Los Angeles, Box 951478, Los Angeles, CA 90095-1478, 310-794-5964, ldelp@ucla.edu and Carles Muntaner, MD, PhD, Center for Addiction and Mental Health, University of Toronto, 250 College St Suite 618, Toronto, ON M5T 1R8, Canada.

The growing need for long term care has stimulated interest in the home care workforce. California's In-Home Supportive Services program (IHSS) employs over 200,000 workers through a consumer-directed model of care. This paper examines the Los Angeles County IHSS workforce (half of those employed statewide), an ethnically diverse group of women (86%), half of whom are immigrants, and three-quarters of whom care for family members. Data from 1,614 respondents were analyzed to examine the relationship between job-related stressors and health outcomes, and to determine if support or control mediates the relationship. Multivariate analysis demonstrates that job-related stressors are significantly associated with self-reported health status (37% have fair-poor health), ability to recover (24% report difficulty) and job satisfaction (41% report low satisfaction) with variation by race/ethnicity. Emotional and physical demands; schedule demands such as hours of work and overtime; and financial strain were significant in one or more models. Control was measured at the macro level (job security and union involvement) and the micro level (decision latitude); control and support both exert a direct rather than a mediating effect. Whether the provider and consumer are related interacts with living arrangements. Future research will require measures that better capture job-related stressors in this unique setting where work and home boundaries are blurred. Policy implications include the need to provide workers sick leave and respite care; allow pay to family members to provide care; and structure models of care to allow for input into policy decisions from both workers and consumers.

Learning Objectives: