Wellbeing of lone working Healthcare Assistants and its impact on staff retention in hospice care at home services.

Introduction Recent UK-based research revealed the complex role of lone working Healthcare Assistants (HCAs) who provide hospice care at home without direct supervision of a registered practitioner.1 The complexity of the role combined with emotional labour,2 support needs and variable preparation1 may have long term implications on wellbeing and retention. Staff attrition leads to inadequate staffing, unmet care needs, and impacts on patient wellbeing.3 4

Aims To investigate wellbeing, intention to leave and support needs amongst lone working HCAs providing hospice care at home.

Methods A mixed-method sequential explanatory design, comprised of two phases 1) a cross-sectional online survey consisting of validated tools and questions designed by the study team, and 2) semi-structured qualitative interviews.

Results 218 HCAs completed the survey (12/04/23 to 08/06/23), 14 HCAs completed interviews (19/07/23 to 31/08/23). Mean wellbeing score was 52.2(SD=8.64). Higher wellbeing scores were related to lower intentions to leave r(216) = -.25, p<.001. Qualitative data (open text survey responses and interviews) shown the main factors negatively influencing wellbeing were loneliness, isolation and feeling undervalued. The main factors positively influencing wellbeing were high job satisfaction and finding the role meaningful. HCAs revealed a strong preference for contact-based support (in-person and virtual). In-person contact was an important prerequisite for building further contact with peers (virtual or via phone). However, support available from line manager and peers varied greatly and had a substantial impact on wellbeing levels and intention to leave, both positively and negatively.

Conclusion Many factors impact on wellbeing level of lone working HCAs providing hospice care at home. As higher wellbeing level was related to lower intentions to leave, supporting staff wellbeing is a key organisational strategy for higher retention of staff.

Impact Understanding HCAs support needs can inform development support strategies to improve wellbeing and increase staff retention.