Collaborative Co-design of Portable Work Benefits Policy Model and Prototype based on Direct Care Workers' Needs, Attitudes, and Beliefs

直接护理人员(DCW)构成了卫生保健中一个基本的、高技能的、快速增长的部分 劳动力。残疾人士中心协助残疾人士和体弱长者进行日常生活活动。DCW减少 通过防止需要住院、住院和其他昂贵的医疗服务来降低医疗成本 在他们的客户之间提供服务。从2016年到2060年，65岁及以上成年人的数量将从 4920万至9470万。18岁到的成年人数量将保持不变，导致家庭短缺 照顾者。2017年，每名85岁及以上的成年人中有31名劳动适龄成年人，但这一比例将 到2060年减少到12个。预计从2019年到2029年，DCW将增长130万。这种增长不会持续下去 与残疾人和体弱老年人的预计增长保持同步。DCW的离职率是 由于工作条件差和薪酬不足，已经很高了，更多的人离开了 劳动力比进入劳动力更重要。探索改善DCW工作条件和补偿的方法至关重要 以防止劳动力进一步短缺。尽管DCW对公众健康做出了巨大贡献，但他们的 由于工作性质、低工资以及缺乏工人保护和传统的 工作福利。DCW容易受到伤害、虐待、传染病和其他不良健康后果的影响 克服了之前列出的缺点。美国的DCW员工队伍主要由以下人员组成 优先人群：女性、种族或少数民族，每四名工人中就有一人是移民。存在的风险 DCW面临的问题加剧了这些优先人群中现有的健康差距。有令人信服的 有证据表明，工作福利可以改善健康状况。工作福利还保护DCW的客户不受 与医疗保健相关的感染，因为DCW将能够在生病时休带薪病假。便携工作 福利是员工可以在不同工作之间随身携带的工作福利，按比例分配 雇主(和客户一样)可以做出贡献，而且所有员工都可以获得。便携工作福利并不广泛 提供，但已被提议作为一种创新的方式，为缺乏工作福利的工人可以获得这些福利。 我们建议1)开展焦点小组讨论，以探索DCW的需求、态度和信仰 关于便携工作福利；2)与DCW举行两次联合设计会议和一次焦点小组会议，以 为马里兰州的DCW制定和完善可移植的工作福利政策模型(与机构代表一起 应邀参加第二次联合设计和专题小组会议)，以及3)举行联合设计会议和专题小组会议 为DCW调整和进一步完善便携工作福利应用程序和网站的会议。这项研究将 为获得DCW的工作福利迈出第一步，保护他们和周围的人的健康， 改善工作条件和薪酬，防止DCW进一步出现劳动力短缺。这 研究还将确保为DCW提供适当的便携工作福利。研究方法和结果 这项研究也可以为其他缺乏传统工作福利的弱势工人群体的研究提供参考。

Direct care workers (DCWs) comprise an essential, highly-skilled, rapidly growing part of the health care workforce. DCWs assist people with disabilities and frail elders with activities of daily living. DCWs decrease health care costs by preventing the need for institutionalization, hospitalization, and other costly medical services among their clients. From 2016 to 2060, the number of adults aged 65 and over will increase from 49.2 million to 94.7 million. The number of adults 18 to 64 will remain the same, leading to a shortage of family caregivers. There were 31 working-age adults for every adult aged 85 and over in 2017, but this ratio will diminish to 12 by 2060. DCWs are expected to grow by 1.3 million from 2019 to 2029. This growth will not keep pace with the projected growth of people with disabilities and frail elders. The turnover rate among DCWs is already high due to poor work conditions and inadequate compensation, with more people leaving the workforce than entering it. It is critical to explore ways to improve DCW working conditions and compensation to prevent further shortages in the workforce. Although DCWs contribute enormously to public health, their health is put at risk due to the nature of the work, low wages, and lack of worker protections and traditional work benefits. DCWs are vulnerable to injury, abuse, infectious diseases, and other poor health outcomes due to the previously listed disadvantages. The DCW workforce in the United States is predominantly comprised of priority populations: female, racial or ethnic minorities, and one in four workers are immigrants. The risks that DCWs face exacerbates existing health disparities among these priority populations. There is compelling evidence that work benefits improve health outcomes. Work benefits also protect clients of DCWs from healthcare-associated infections as DCWs would be able to take paid sick leave when ill. Portable work benefits are work benefits that employees can take with them from job to job, prorated so that multiple employers (like clients) can contribute, and accessible to all workers. Portable work benefits are not widely available but have been proposed as an innovative way for workers who lack work benefits can receive them. We propose to 1) conduct focus group discussions to explore the needs, attitudes, and beliefs of DCWs regarding portable work benefits; 2) hold two co-design sessions and a focus group session with DCWs to develop and refine a portable work benefits policy model for DCWs in Maryland (with agency representatives invited to the second co-design and focus group sessions), and 3) hold a co-design session and a focus group session for adapting and further refining portable work benefits apps and websites for DCWs. This study will provide a first step toward obtaining DCWs work benefits that will protect their health and those around them, improve work conditions and compensation, and prevent further workforce shortages among DCWs. This research will also ensure that portable work benefits for DCWs are appropriate. The methods and results of this study can also inform research for other vulnerable worker populations that lack traditional work benefits.