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This Physician Is on a Mission to Empower Home Health Aides. Here's How She's Doing It.

Dr. Madeline Sterling shares how she's working to improve the lives of home health aides and their patients. Plus, her advice on other researchers trying to pioneer a new space in their field.

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Dr. Madeline Sterling is a board-certified general internist and health services researcher. As an Assistant Professor of Medicine at Weill Cornell Medicine, her research aims to improve healthcare delivery for adults with chronic conditions, with a specific focus on home health care and empowering the home health aide workforce to improve patient care. She sat down with Jessica Abo to discuss her research and her advice for anyone looking to be a pioneer in their field.

Jessica Abo: Dr. Sterling, did you always know you wanted to pursue this field?

Dr. Madeline Sterling: I always knew I wanted to become a primary care doctor. I love being a primary care doctor and that I can have relationships with patients throughout their lives. I take care of their medical problems, but I also get to know what really matters to them. What are their values for their health?

Tell us about your research and the course you developed for home healthcare workers.

Dr. Sterling: Many patients I care for rely on caregivers in the home to help them manage their chronic illnesses. And one common condition that they use home health aides for is heart failure, which is a chronic cardiovascular disease where the heart doesn't pump blood well to the rest of the body. And we found that home health aides were actually helping patients manage key aspects of
their care, like monitoring their symptoms. And yet there's really not much research about who they are and what this workforce does. We surveyed over 800 home health aides over the last several years in New York City. And we found that more than half have never received training on this disease. And so our team set out to design and pilot test the first heart failure training course for this workforce. And we're currently in the midst of a clinical trial, which is testing the impact of this training on workers and their patients with VNS Health.

At the core of everything you do is the desire to help people age in place. What does that mean exactly and why is this so challenging for our country?

Dr. Sterling: 75% of adults currently want to stay at home. They want to grow old and be at home and feel good and many don't want to go to a nursing home. And yet our current healthcare system is not set up with the infrastructure to do this. We lack a long-term care support system with caregivers.

What can we be doing about this problem?

Dr. Sterling: We need a better-supported home care workforce and we need policies in place that can actually allow them to thrive and value what they do for patient care.

Where do family caregivers come into all of this?

Dr. Sterling: Family caregivers are so important. One in five adults is currently caring for loved ones in the home. And right now they're overwhelmed. They are not only managing their loved one's chronic illnesses, but they're also trying to navigate how to find home health aides for their families. And this is a huge burden. So we have a lot of work to do, especially as the baby boomer
population continues to age rapidly.

And speaking of work, you are doing research in this area and that research is expanding. You just want a prestigious Doris Duke award, which is given to 16 early career physician-scientists a year. How will you be using your grant to advance your work?

Dr. Sterling: Up until now, we've focused on training home health care workers to help patients with certain chronic conditions. We're now shifting the focus to actually improve the health of the caregivers themselves. And I'm so excited about this. We spoke with so many home health aides, and many of them said they were really struggling to manage their mood and their stress. And so in this study with this foundation funding, we'll actually be testing and rolling out a new health promotion program, which will hopefully improve the mental health of home health aides.

When you roll out this 10-week program, what are some of the things that these home
health aides will be learning?

Dr. Sterling: They'll be learning how to manage stressful situations on the job. How do you replace negative thoughts with positive ones, how to eat better, and get more physical activity? And those are just to name a few. They'll actually be learning a whole health curriculum.

Finally, Dr. Sterling, what advice do you have for other researchers trying to pioneer a new
space in their field, given your own experience of doing this?

Dr. Sterling: I have three key pieces of advice. The first is to tackle important problems. Not only should it be important to you, but it should be important to a large number of people and also probably funding agencies. The second is to follow your passion. You're going to be working on research for a long time and make sure you can also communicate that passion well. Not only to scientists but to lay community members and others who need to understand what you do. And finally, this work takes a village. You really have to assemble a team with multidisciplinary experts and people who share your values.

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