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November 08, 2007
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In This Issue:
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Tool Helps CNAs Assess Pain in People with Dementia
A study published in the April-May issue of the American Journal of Alzheimer's Disease and Other Dementias finds positive outcomes associated with a pain assessment tool for CNAs working with nursing home residents with dementia. The tool helped CNAs detect pain promptly, communicate better with other licensed staff, and solidify their position as members of the caregiving team, thus breaking down many barriers to pain alleviation.
According to "Use of the Certified Nursing Assistant Pain Assessment Tool (CPAT) in nursing home residents with dementia," no quality of life indicators were seen to improve in the residents. However, the authors note, that this may have been due to the short length of the study period (six months), the relatively small number of residents studied, the frequency with which the tool was used (just once a week or as needed), or the difficulty of preventing decline in people with a significant number of co-morbid illnesses.
The article is free to subscribers only; others must pay to download a copy.
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Recent additions
Click here to see what's new in the Clearinghouse.
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HCHCW Cohosts Direct-Care Workforce Forums with Alzheimer's Association
"There are not enough workers entering -- and remaining in -- the direct-care workforce to meet the increasing demand from long-term care consumers, and one of the reasons is the absence of health coverage for the employees," said an article in the October 26 New Hampshire Business Review.
The story was about an October 17 forum on the growing direct-care crisis - and the role of health care coverage in creating a more stable workforce. The Concord, New Hampshire, roundtable discussion was co-sponsored by Health Care for Health Care Workers and the Alzheimer's Association.
Direct-care worker Jennifer Craigue, pictured above, was one of the panelists.
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Health Insurance Vital to Job Retention
A new fact sheet from Health Care for Health Care Workers reports on a growing number of studies showing a strong, positive link between health insurance benefits for direct-care workers and worker retention. Studies find that health insurance may be more important than wages in reducing turnover and increasing the supply of direct-care workers.
"I Can't Afford to Cover My Employees' Basic Needs"
"It's important for me to provide coverage because we have some great employees I hope to keep," says Lori Michaels, the executive director of a home care agency in Pennsylvania, in a new testimonial on the Health Care for Health Care Workers website. "I'm constantly having to hire new workers, and I'm often short staffed because the turnover rate is so high.
"If my workers could get on a subsidized insurance plan with no co-pays or deductibles," she adds, "I believe I'd have much happier workers and a much higher retention rate. I'm frustrated because I can't afford an insurance plan that is sufficient to cover their basic needs."
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More Information
Click here to read more from and about the HCHCW campaign.
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Presentations on Culture Change Available to Download
A series of recent presentations on the how and why of culture change in long-term care can be downloaded as a video, podcast, or transcript on the Kaiser Family Foundation website. The presentations were sponsored by the Alliance for Health Reform and the Robert Wood Johnson Foundation.
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If you're reading this in a web browser, return to your e-mail to vote. Votes cast from the browser are not counted.
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Dear Friend,
For people interested in improving direct-care jobs and long-term care quality, the pace of change sometimes seems glacial. But if talk leads to action, there's plenty of reason for hope in this issue of Quality Care/Quality Jobs. Researchers are gathering valuable data on worker demographics and dilemmas, while advocates and other experts testify about current conditions and the need for change.
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Writing Things Down Makes Them Real: Celia Berdes on the Power of Research
"In a way, the whole long-term care system is upside down," says Celia Berdes, PhD, a gerontologist and sociologist at Northwestern University and director of research at Presbyterian Homes in Evanston, Illinois. "The things that are the most important are the least valued, and the things that are the least important are the most valued."
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Fair Home Health Care Act Is "An Historic Opportunity," House Hears
Another step was taken in the direction of possibly extending minimum wage and overtime protection to home care aides when the House Committee on Education and Labor Subcommittee on Workforce Protections held a hearing on October 25. The hearing was on a proposed bill that would change the wording of an amendment to the Fair Labor Standards Act.
"HR 3582 offers Congress an historic opportunity to send three important economic and social signals," testified Dorie Seavey (pictured above), PHI's director of policy research, at the hearing. "First, that home care workers should be on an equal footing with respect to all other low-wage occupations. Second, that, within long-term care, the home care labor market should not have second-class status with respect to compensation--and, therefore, with respect to its ability to attract and retain workers. And finally, that federal lawmakers can work together to coordinate, rather than send conflicting messages about, the direction of our nation's long-term care policy."
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Editorial Calls for Equity for Home Care Aides
PHI President Steven L. Dawson also laid out the case for extending FLSA protection to home care aides last month, in the guest editorial of the October issue of Nursing Homes Long Term Care Management.
Acknowledging that paying overtime would increase the cost of home care, Dawson wrote that he is "perfectly comfortable" with using that as a reason to deny those workers overtime pay - as long as the same logic is applied to all public servants. "Therefore, for example, neither should we pay policemen or firemen overtime - for it clearly drives the cost of services up, and if we didn't have to pay each one of them so damn much, we could put a whole lot more of them out on the streets to serve us.
"So what's the difference between firemen and home health aides? Mostly gender, race, and class," Dawson continues. "Clearly, the long-term care system has simply presumed that an endless supply of low-income women will always be available to transfer our mothers from bed to wheelchair, or to feed our fathers, no matter how poorly we pay them, or train them, or support or supervise them."
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Senate Committee Hears about Need to Improve Direct Service Jobs
In other recent testimony before a Congressional committee, a member of ANCOR told members of the Senate Committee on Health Education Labor and Pension about the need to improve direct-service jobs in order to solve the workforce crisis.
According to the September issue of ANCOR Links, Shawn Griffin, the CEO of Community Entry Services in Wyoming, spoke at a hearing on how to make long-term services and supports more accessible to elders and people with disabilities. Griffin "received nods in agreement by all witnesses when he addressed the workforce crisis and included as an important step to address the problem the specific work ANCOR is undertaking on the Direct Support Professionals Fairness and Security act of 2007 (H.R. 1279)," the newsletter reports.
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AAHSA Outlines Steps to an Ethical Workplace
"When each member of the workforce within an organization is respected, treated with dignity and paid a just wage, it reasonably follows that such an organization is more likely to experience higher quality service, lower turnover and greater overall success," declares a white paper published by the American Association of Homes and Services for the Aging (AAHSA) Commission on Ethics in Aging Services.
Our Moral Imperative: Creating an Ethical Workplace begins with the premise that "employees of AAHSA organizations deserve a safe, just workplace in which they are respected and adequately supported in fulfilling their roles, and in which they can develop both professionally and personally." It defines seven ethical principles that apply to the long-term care workforce, including respect, autonomy, participation, and justice; discusses the forces that often hamper their development; and recommends concrete steps organizations can take to improve the work environment and better support workers.
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BLS Journal Profiles Direct-Care Workers
A cover story in a widely read U.S. Bureau of Labor Statistics journal illustrates just how far we are from achieving AAHSA's vision of a well-supported and fairly paid workforce. "Caring for America's Aging Population: a profile of the direct-care workforce" paints a portrait of the direct-care workforce in long-term care as "a low-wage workforce with correspondingly low levels of health insurance coverage and high levels of turnover."
Authors Kristin Smith and Reagan Baughman use 2006 Annual Social and Economic Supplement to the Current Population Survey (CPS), together with data from the 2005 and 2006 CPS reports, to profile direct-care workers, who make up 2 percent of the total American workforce. Because 89 percent of all direct-care workers are women, the authors compare their demographics to those of the female workforce as a whole. Direct-care workers earn more than a third less than female workers as a whole ($17,228 vs. $30,441 a year) and they are significantly less likely to have health insurance (25 percent are uninsured, compared to 16 percent of the female workforce overall). Average annual turnover for direct-care workers is also unusually high, at nearly 40 percent.
The article also discusses the implications of these factors for the people served by direct-care workers. It was published in the September issue of the Monthly Labor Review.
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Depression Dogs Personal Care Workers
Given those conditions, it's no wonder direct-care workers suffer high rates of depression.
According to a report from the Substance Abuse and Mental Health Services Administration, personal care and service workers -- a category that combined direct-care workers in long-term care with child care workers -- had the highest rates of depression of any class of workers in the nation. Almost 11 percent of personal care workers reported at least one "major depressive episode" in the past year, which was defined as "a period of two weeks or longer during which there is depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration and self-image."
Overall, an estimated 7 percent of full-time workers and 12.7 percent of unemployed workers faced depression in the past year.
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DCA Launches E-Newsletter
A new e-newsletter from the Direct Care Alliance (DCA) highlights the organization's activities, plans, and programs. Lively and informative, Direct Care Alliance: E-News and Notes is a quick read with plenty of links and pictures.
Click here to subscribe.
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PHI Recognized for Innovation
PHI, the parent organization of this newsletter, will receive two awards this month.
On November 14, PHI President Steven L. Dawson will be given the 2007 Cindy Marano Trailblazer Award for Innovative Leadership in Sector Workforce Development by the National Network of Sector Partners. The award honors "innovation and excellence in industry-specific workforce strategies, bridging the needs of employers and workers." Dawson was selected by a national committee of senior workforce development practitioners who work - as he does - within a particular sector of the workforce. Dawson has been the president of PHI since it was founded in 1992.
In addition, PHI was named one of two winners of the 2007 Commissioner's Award for Innovation by Edwin Méndez-Santiago, Commissioner of the New York City Department for the Aging. The commissioner presented PHI's award to Dawson on November 7 for work on behalf of direct-care workers who assist older New York City residents in their own homes. PHI sponsors Pathways to Independence, a home care service and training network in New York City.
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November 13, 2007
The 3nd Annual Pennsylvania Accord, Lancaster, PA
November 14, 2007
Vermont Association of Professional Care Providers (VAPCP) Statewide Conference, Montpelier, VT
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