“Homecare” (or “attendant services”) is a primary mode of long-term care. In the U.S., approximately 1 million homecare workers – mostly midlife, low-SES women – provide personal care services for elders and persons with disabilities who live in community settings. An emerging trend is “consumer-directed” services, which allows recipients (not an agency) to decide how, when, and from whom they receive their supportive services. This approach is widely used in Medicaid personal care programs; in many programs, homecare workers are “independent providers” employed by the homecare recipients. The changing organization of homecare work poses significant challenges for documenting occupational injury and workers' access to workers' compensation – vital information for addressing occupational hazards in homecare and improving working conditions for these vulnerable workers. Although international homecare research documents widespread and disabling occupational injury, current U.S. occupational injury surveillance systems may not adequately capture these injuries, especially among independent providers. Given the increasing demand for homecare, it is important and timely to focus on these issues. This study assessed how occupational injuries in homecare are categorized, tracked, and reported across states. We surveyed each state's workers' compensation agency, and over 50 Financial Management Services used in Medicaid personal care programs to handle the personnel/fiscal tasks (e.g., payroll). Questions covered: classification/categorization of homecare workers, availability of workers' compensation coverage, FMS activities related to occupational injury recording and reporting, and availability of occupational safety training for homecare workers. Preliminary results indicate that substantial gaps exist regarding occupational injury surveillance in homecare, especially regarding independent providers.

Learning Objectives:

At the end of the session, participants will

• Describe how the changing organization of homecare work may result in different ways homecare workers are categorized, and the implications for access to workers’ compensation coverage


• Describe how existing occupational injury surveillance systems count (or do not count) occupational injury in homecare


• Describe how FMS may play a role regarding occupational injury recording and reporting

Keywords: Data/Surveillance, Home Care