Objectives: To identify factors associated with high and low "voice" - or level of input in patient care decisions - among home care workers (HCWs), an often marginalized workforce that provides care in the home to older adults and those with chronic conditions.

Design: We conducted a secondary analysis of data from a cross-sectional survey assessing experiences of HCWs in caring for adults with heart failure. The survey measured HCWs' voice using a validated, 5-item instrument.

Setting and Participants: The survey was conducted virtually from June 2020 to July 2021 in partnership with the 1199 Service Employees International Union (1199SEIU) Training and Employment Funds, a union labor management fund. English-or Spanish-speaking HCWs employed by a certified or licensed home care agency in New York, NY, were eligible.

Methods: HCW voice was the main outcome of interest, which we assessed by tertiles (low, medium, and high, with medium as the referent group). Using multinominal logistic regression, we calculated odds ratios (ORs) and 95% CIs for the relationship between participant characteristics and low and high levels of voice. Results: The 261 HCWs had a mean age of 48.4 years (SD 11.9), 96.6% were female, and 44.2% identified as Hispanic. A total of 38.7% had low voice, 37.9% had medium voice, and 23.4% had high voice. In the adjusted model, factors associated with low voice included Spanish as a primary language (OR 3.71, P ¼ .001), depersonalization-related burnout (OR 1.14, P ¼ .04), and knowing which doctor to call (OR 0.19, P < .001). Factors associated with high voice included Spanish as a primary language (OR 2.61, P ¼ .04) and job satisfaction (OR 1.22, P ¼ .001).

Conclusions and Implications: Organizational factors such as team communication practices - including among non-English speakers - may play an important role in HCW voice. Improving HCW voice may help retain HCWs in the workforce, but future research is needed to evaluate this.