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June 05, 2007
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In This Issue:
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Good Training, Rewards, and Scheduling Can Cut Down on Turnover
A study of certified nursing assistants (CNAs) verifies that job satisfaction is associated with lower turnover rates. Training, rewards, and work schedule, the study finds, are particularly important aspects of CNA job satisfaction.
"Job Satisfaction of Nurse Aides in Nursing Homes: Intent to Leave and Turnover" notes that formal caregivers in long-term care - particularly CNAs - are "the linchpin to helping provide quality care." The article highlights several initiatives that address turnover and explains the link between turnover and care quality. "At its best," says a PHI report quoted in the article, "caregiving is a personal relationship; it thrives on familiarity and the intimate knowledge of both parties of the other's routines and preferences. Constant churning of staff interrupts this relationship as consumers and new workers must continually reorient to each other."
The article was published in the April 2007 issue of The Gerontologist.
Preparing for the Baby Boomers' Big Bang
According to a new report by the Urban Institute, changes in disability levels, financial resources, and adult children's availability will increase future demand for long-term care services. "Even under the most optimistic scenario long-term care burdens on families and institutions will increase substantially in coming decades," says Meeting the Long-Term Care Needs of the Baby Boomers: How Changing Families Will Affect Paid Helpers and Institutions.
The study projects to 2040 the number and percentage of people ages 65 and older with disabilities and their use of long-term care services, calculating that declines in average family sizes will increase the share of older adults receiving paid help from 22 to 26 percent, as the share of those receiving unpaid help from family members falls from about 28 to 24 percent. At the same time, rapid population growth is expected to substantially boost the number of older people needing care, causing the number receiving paid home care and the number of older nursing home residents to more than double.
Whether high quality and affordable care will be available to the nation's aging population depends largely on future policy choices, the authors warn. "Problems recruiting and retaining long-term care workers could limit the availability of paid services and sharply raise costs," they argue. Therefore issues involving the financing and organization of long-term care "deserve more attention from policymakers."
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Recent additions
Click here for more news from the Clearinghouse.
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HCHCW Pennsylvania Leader Addresses the Press, State Legislators
Tracy Lawless (pictured above), campaign coordinator for the Pennsylvania Healthcare for Healthcare Workers initiative, spoke at a May 3 press conference in support of the proposed Prescription for Pennsylvania legislation.
HCHCW's parent organization, the Paraprofessional Healthcare Institute, has joined with several Pittsburgh-area groups, including Consumer Health Coalition and Mon Valley Unemployed Committee, to support of the legislation. The coalition held its press conference before the state House Insurance Committee's second day of hearings on the bill. Addressing the media before the hearing began, they spoke about the need for affordable, quality health care for all Pennsylvanians.
The coalition also sent a letter to state legislators urging them to support the legislation. "The Prescription for Pennsylvania would reduce health care costs and, we believe, slow the growth in insurance premiums that continues to force more employers to drop coverage and swell the ranks of the uninsured," the letter says.
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Case Study Analyzes Multi-Employer Health Plans
Comprehensive Health Coverage for Consumer-Directed Home Care Workers, a six-page case study by HCHCW consultant Ingrid McDonald, describes a multi-employer trust in Washington state that provides health benefits to home care workers. The report outlines eligibility requirements, benefits and costs of coverage. It also looks at why enrollment rates were lower than predicted. While improvements can be made, the report concludes, the program meets nearly all design features necessary for quality coverage.
The case study is a more detailed look at a project covered in another HCHCW report published earlier this year, Emerging Strategies for Providing Health Coverage to the Frontline Workforce in Long Term Care: Lessons from the CMS Direct Service Community Workforce Demonstration Grants .
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More Information
Click here to read more from and about the HCHCW campaign.
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Alabama Adds Consumer-Directed Care to Medicaid Menu
Late last month, Alabama became the first state to earn federal approval to add consumer-directed personal assistance services to the care covered by its Medicaid plan, eliminating the need for repeated requests for time-limited section 1115 demonstration programs or section 1915(c) waiver programs. Secretary Mike Leavitt of the U.S. Department of Health and Human Services lauded the development in an HHS press release, saying: "When beneficiaries direct their own care, we have found, there are fewer unnecessary institutional placements, higher levels of beneficiary satisfaction, fewer unmet needs, less worker turnover and an efficient use of community services and supports."
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Which of these staffing ratio would be best for a nursing home's day shift?
1:5--50%
1:7--17%
1:10--33%
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Dear Friend,
As usual lately, there are job openings at the rapidly growing Paraprofessional Healthcare Institute, this newsletter's parent organization. To learn more about the positions open here and at the Direct Care Alliance, a PHI affiliate, please scroll down to the bottom of our website's home page.
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Grant Money Available for Provider-Educator Partnerships, Research
Grant money is available from the Robert Wood Johnson Foundation's Job to Careers program for health care organizations that are working with educational institutions to improve care quality by improving the frontline workforce.
The $15.8 million national initiative will fund both research studies and partnerships aimed at advancing and rewarding skill and career development in incumbent workers. The partnerships must include at least one health or health care employer and at least one educational institution (e.g., community college) that provides academic credit or an industry-recognized credential.
Step one of the three-step application process, the submission of a brief proposal, must be completed by June 12.
Click here for more information or to apply.
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The Garment Workers of the Modern New York Economy
"In many ways, home-care aides are the garment workers of the modern New York economy," says a front-page feature in the May 25 issue of the New York Times. "The working conditions may be better, but the low pay, skimpy benefits and weak prospects for upward mobility tend to draw mostly immigrant women with few marketable skills."
In "For New York, Big Job Growth Is in Home Care," reporter Patrick McGeehan notes that frontline jobs in health care and social services organizations (childcare centers, doctors' offices, and food banks as well as nursing homes, home care, and hospitals) account for a growing share of the nation's employment - and as much as a third of all jobs in some parts of New York City. That's good for the economy, he notes, but it's not as good as it could be, since pay and benefit levels for these jobs tend to be poor - in part because so many immigrants are available to do the work.
"People who want to get control of health care spending should be careful what they wish for," says a health-care economist at the University of Pennsylvania's Wharton School. "Spending less on health care would actually be harmful to the local economy because it's a good source of jobs." McGeehan also quotes home health aide Karlyne A. Mills, who says: "From the time that I became a home health aide, I always wondered why this job is so important and why our pay is so low."
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BLS Releases Latest Demographic Report on Direct-Care Workers
"Maintaining a sufficiently large workforce to care for the growing elderly population represents a potential challenge facing the U.S. economy over the next several decades," concludes the U.S. Bureau of Labors Statistics' latest demographic report on direct-care workers.
Occupational Composition of the Elder Care Industries, May 2005 divides long-term care into four types: home health care services, nursing care facilities, community care facilities, and services for the elderly and persons with disabilities. All but nursing homes, it notes, are experiencing "phenomenal growth" and are expected to continue to do so in the near future, with home health employment, the fastest-growing of the sectors, expected to increase by nearly 70 percent between 2004 and 2014.
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Harris Poll: Americans in the Dark about Home Care Aide Training
Most Americans who hire in-home caregivers think they have received more formal training than they have, according to a Harris poll conducted for the Caregiving Project for Older Americans. The poll found that 78 percent of people who have hired an in-home caregiver for someone over 65 believed that the person received formal training.
"The public has a dangerous misperception about the amount of training these in-home caregivers are receiving," said Co-Director Dr. Larry Wright in a Caregiving Project press release. "The truth is that professional caregivers today are often unskilled or poorly trained."
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Caregiving Project Names Advisory Council
In other recent news, the Caregiving Project announced the appointment of several high-profile leaders to its national advisory council.
According to a press release, the new appointees include former First Lady Rosalynn Carter; television journalists Walter Cronkite and Hugh Downs; Humphrey Taylor, chairman of The Harris Poll; Dr. John Finnegan, Dean of the University of Minnesota's School of Public Health; Val Halamandaris, founder and president of the National Association of Homecare and Hospice; Carol Raphael, president and CEO of Visiting Nurse Service of New York; and Hall of Fame football player Frank Broyles.
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Arizona Appoints Direct Care Workforce Specialist
Arizona's Aging and Adult Services division has created a new position to help fill the state's growing care gap.
Jutta Ulrich, the state's first direct-care workforce specialist, will work with other state officials, providers and community agencies to measure the caregiver shortage in Arizona, develop training standards for caregivers in different settings, and devise a pay scale to attract and retain more people to the field, according to an April 17 article in the Arizona Daily Star.
The position was recommended by the Citizens Work Group appointed by Governor Janet Napolitano in 2004.
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Iowa Law Supports Direct-Care Worker Initiatives and Studies
The Health and Human Services Appropriations bill signed into law in Iowa on May 29 includes four items of significant interest to Iowa caregivers:
An appropriation of $75,000 to the Iowa Department of Public Health to implement the work of the Direct Care Worker Task Force.
An appropriation of $140,000 to an "independent statewide direct care worker association" for "education, outreach, leadership development, mentoring and other initiatives intended to enhance the recruitment and retention of direct care workers in health and long-term care."
A requirement that various state agencies collaborate to conduct a comprehensive review of the health and long-term workforce, documenting workforce shortages; discussing their impact on access to, cost of, and quality of care; and submitting a detailed plan to address them by January 15, 2008.
The creation of a Legislative Commission on Affordable Health Care Plans for Small Businesses and Families to make recommendations for health care reform, including the benefits and costs of providing health insurance coverage for all Iowans. That commission will submit a report for consideration by the Iowa Legislature in 2008.
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What Do Home Care Workers Want?
In a demographic study of Canadian home support workers, the workers asked for better wages, benefits, and schedules. "Since these workers are the largest segment of formal care providers and the mainstay of formal support services for chronically ill seniors, attention to their issues is critical to the sustainability of the home care industry," notes author Linda S. Nugent in "Can't They Get Anything Better? Home Support Workers Call for Change."
The article was published in Home Health Care Services Quarterly, Vol. 26 No. 2 2007.
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Violence and Abuse of Home Care Aides: A Public Health Problem
Home care organizations should do more to reduce violence against caregivers by clients and to help workers overcome the depression that can result when they are the victims of violence, according to "Abuse and Violence During Home Care Work as Predictor of Worker Depression."
The study, which was published in Home Health Care Services Quarterly Vol. 26 No. 1 2007, found that workers frequently experience or witness violence or abuse at the hands of the people they care for in the home, and that abuse puts them at increased risk of depression. Given the size of the home care workforce, the study notes, "abuse and violence occur to a large number of workers and represent a serious public health problem."
In a related article, "Barriers to Documenting Occupational Injuries Among Personal Assistance Services Workers," researchers Teresa Scherzer and Robert Newcomer found that variations in workers compensation reporting requirements lead to an undercounting of the prevalence and consequences of on-the-job injuries among personal assistance workers employed by agencies. The authors also found that injuries to workers employed directly by the consumers they serve are rarely reported at all. The study was published in the American Journal of Industrial Medicine.
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Book Bears Witness to the Culture Change Process
"People involved in making nursing homes better places to live and to work describe the process as a journey, never a destination. Using that metaphor, I have observed that the further along the road they are, the more fully empowered the staff - and the better off the residents, whether the measure is quality of health care or the more elusive quality of life," writes Beth Baker in Old Age in a New Age (Vanderbilt University Press).
Baker explores the nursing home culture change movement by interviewing experts and visiting homes that have transformed their organizational cultures in order to become more person-centered. In a chapter examining the role of CNAs in nursing homes and how that role changes in transformational homes, she describes a "train the trainer" session on how to implement a coaching style of supervision. Baker quotes trainer Sue Misiorski of the Paraprofessional Healthcare Institute as saying: "Workers don't leave their jobs. They leave their supervisors. If an employee thinks you don't believe in them, they will leave you."
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Long-Term Care is a Women's Issue, Says AARP
Long-term care is a women's issue, with more than two-thirds of the care recipients, about 90 percent of the paid caregivers, and the great majority of the family caregivers all female, notes Women and Long Term Care, a two-page AARP issue brief. The brief notes that paid workers "tend to have low pay and uneven hours.... [and] no benefits."
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June 14-21, 2007
National Nursing Assistants' Week
June 16-19, 2007
Festival of International Conferences on Caregiving, Disability, Aging and Technology, Ontario, Canada
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