safety. She has been involved in research on smart homes (discussed in Chapter 3), and this research needs to take into account the experiences of direct-care workers, and especially paraprofessionals like home health aides, companions, and homemakers who are in homes for longer periods of time than are nurses, therapists, or dieticians.

As part of an exchange on the educational requirements for nurses, Milone-Nuzzo observed that research has demonstrated that health outcomes improve as the education of nurses increases. “I say this in the most kind and gentle way: we need to increase the education [level] of nurses,” she remarked. Humphrey pointed out that other caregiver disciplines, such as physical therapists, are increasing their educational requirements. A lack of attention to both education and certification will have a negative impact on home health care, she said.

In response to a question about whether human factors research considers the positive aspects of systems, Charness observed that this research looks to optimize not only efficiency and safety but also comfort. Schulz added that there is a positive side to informal family caregiving “in that individuals do report positive benefits.” Quinn reported on a survey with which she has been involved of 1,200 home health care nurses working with AIDS patients, in which a majority responded that they are satisfied with their work. The nurses particularly cited the autonomy of their work and the relationships they formed. “When they can have meaningful ongoing relationships, … that is the most rewarding to them, and that’s why they are doing it.”

Committee chair David Wegman asked whether distinguishing between formal and informal caregivers is the proper frame of reference or whether a distinction between more and less intense levels of involvement may be preferable. Milone-Nuzzo agreed that there is a great deal of overlap between formal and informal caregivers, especially in terms of the relationships that develop, the physical tasks involved, and the use of medical equipment. Yet distinguishing between these two groups does offer a “lens to begin the conversation.” Schulz added that informal caregivers also rely on formal caregivers for various services, creating a back-and-forth dynamic between the two groups. Humphrey pointed to some of the complications in the distinction. For example, a home health aide could work for a Medicare-certified agency during the week and for a private-duty agency on the weekends, providing care in different environments to different individuals.

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