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This study examines the unique challenges facing rural home care workers. Semi-structured interviews were undertaken between July 2021 and February 2022 with 23 participants that have experience in rural home care delivery. The major challenge confronting rural home care workers involved distance and transportation. This challenge emerged due to long distance between clients, unreliable vehicles, inadequate reimbursement, and inclement weather. In turn, this challenge exacerbated three other types of challenges facing rural home care workers: workforce challenges that consisted of a persistent labor shortage and shorter visits that forced workers to rush through tasks, client isolation due to the social and physical seclusion of households, and the poor working conditions of home care work more broadly. Without policy interventions that respond to these particular challenges, the care gap in rural areas can be expected to grow. 

Home care workers (HCWs) are increasingly central to post-acute and long-term health services in the United States. Despite being a critical component of the day-to-day care of home-dwelling adults, these workers often feel underappreciated and isolated on the job and come from low-income and marginalized backgrounds. Leveraging the support of peers is one potential way to empower HCWs, but peer support encompasses a broad range of activities and aspects. Traditional conceptions of workplace support may not be appropriate to the home care context, as HCWs are a distributed workforce who have few opportunities to interact with each other. In this study, we explore how HCWs value and conceptualize peer support. Our findings demonstrate the importance of peer support in performing the emotional labor of home care work and ongoing attempts to strategically frame the home care profession as essential and medical in nature. Our results ground design implications for technology-enabled peer support based on the power dynamics of our participants' context and allow us to engage with issues where technology design for empowerment intersects with exploitation in distributed or crowd work, emotional labor, and tacit knowledge. 

Abstract ObjectiveTo understand the perspectives of home health aides (HHAs) toward their own health and health behaviors, and how their job impacts both. Data Sources and Study SettingInterviews were conducted with 28 HHAs from 16 unique home care agencies from August 2021 to January 2022. The study was conducted in partnership with the 1199SEIU Training and Employment Fund, a labor‐management fund of the largest health care union in the US. Study DesignA qualitative study with English and Spanish‐speaking HHAs. Interviews were conducted using a semi‐structured topic guide, informed by Pender's Health Promotion Model and the National Institute for Occupational Safety and Health's Total Worker Health Model. To be eligible, HHAs had to be currently employed by a home care agency in New York, NY. Data Collection/Extraction MethodsInterviews were recorded, professionally transcribed, and analyzed thematically. Principal FindingsThe 28 HHAs had a mean age of 47.6 years (SD 11.1), 39% were non‐Hispanic Black, 43% were Hispanic, and they had a mean of 14.1 years (SD 7.8) of job experience. Five themes emerged; HHAs were: (1) Healthy enough to work, but were managing their own chronic conditions while working; (2) Motivated to be healthy, in part driven by their desire to care for others; (3) Worked closely with sick patients, which influenced their perceptions of health; (4) Experienced occupational and patient‐level barriers to practicing healthy behaviors; (5) Sought support and resources to improve their health and wellbeing. ConclusionsHHAs have numerous health challenges, many of which are influenced by their job. Culturally and occupationally tailored interventions may mitigate the barriers that HHAs experience to achieve optimal health.