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November 21, 2006
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In This Issue:
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Portrait of Peg Ankney
"I have always been around someone who was in need of care. Growing
up, I had grandparents nearby whose health I saw deteriorate. I'm
also the oldest of eight kids, so there was always plenty to do
there. In junior high school, I used to go by and visit with some of
the [hospital] patients and read to them. When I became older, I
realized that this is something I enjoyed, working with the older
patients. It just seemed to be a natural thing for me.
Click here
for the rest of Peg's story.
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Recent Additions
Click here
to see more of what's new in the Clearinghouse.
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Maine PASA Invites Lawmakers to "Walk a Mile in My Shoes"
Maine PASA (Personal Assistance Services Association), a statewide
direct-care and support worker organization, is embarking on a
two-month project aimed at educating key long-term care stakeholders
about the need for health coverage for direct-care workers. A "Walk a
Mile in My Shoes" program, coupled with legislative advocacy training
for workers and partnerships with service providers and other
supportive stakeholders, will focus on building relationships with
legislators, community leaders and policy makers and educating them
about the need for affordable health care coverage for direct-care
workers. "Our goal is to match up at least 25 workers and
legislators from around the state in preparation for the 2007
legislative session," said Maine PASA Executive Director Roy Gedat.
"We are building the capacity of the personal assistance workforce to
advocate on behalf of their clients and themselves to insure better
jobs and better care into the future." For more information, contact
Maine PASA at 207-890-0773 or
rggedat@exploremaine.com.
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Group Coverage and Premium Subsidies in Wisconsin
According to
Subsidizing Health Insurance Coverage for the Home Care Workforce in Two Wisconsin Counties: An analysis of options,
the key to expanding health care coverage for direct-care workers
who work for small agencies is keeping their premiums low, minimizing
the administrative burden for their employers, and ensuring that the
amount employers must pay for insurance is manageable and will remain
stable over time.
The paper looks at a new professional employer organization (PEO)
created to make health insurance affordable for home care workers and
child care providers in Wisconsin. The PEO reduces costs by providing
for group purchasing by small home care agencies and by subsidizing
part of the cost of coverage for both workers and employers.
Subsidizing Health Insurance Coverage, which was published by the
Paraprofessional Healthcare Institute's Health Care for Health Care
Workers (HCHCW) initiative, describes the Wisconsin initiative and
the potential sources of public funding for subsidizing insurance
costs. Authors Tameshia Bridges and Carol Regan also recommend other
ways of making health insurance affordable for direct-care workers.
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Free Advocacy Materials Available
New campaign materials from HCHCW are now available for use by people
working to expand health care coverage for direct-care workers. The
materials focus on the "2 in 5" message, which signifies the
approximately 2 in 5 direct-care workers nationwide who do not have
health insurance. To request free copies of the new HCHCW brochure or
fact sheet or the 2 in 5 buttons or stickers, write to
info@hchcw.org.
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More Information
Click here to read more from and
about the HCHCW campaign.
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Clearinghouse Helps Consumers Plan for Long-Term Care
Next time someone asks you for basic information about long-term care
for themselves or a loved on, you might direct them to the new online
clearinghouse developed by the U.S. Department of Health and Human
Services.
The National Clearinghouse for Long-Term Care Information
provides information and options to help people plan for future
needs, as well as sections describing what long-term care is and how
it is paid for.
A Brief History of DD
Parallels in Time II, a
free online resource from the Minnesota Governor's Council on
Disabilities, tells the recent history of Americans with
developmental disabilities, documenting important societal and
legislative milestones from 1950 through 2005. It includes resources,
sections on how language has evolved and on the development of
appropriate public education for all children and of real jobs in
typical work settings, a summary of the proceedings of the Alliance
for Full Participation held in September 2005, and more.
Family Caregiving by the Numbers
A state-by-state analysis of the number of family caregivers,
hours of caregiving services, and their estimated market value is now
available from the Family Caregiver Alliance and National Family
Caregivers Association. To view the data,
click here
or
here
or
here.
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Why are wages so low for direct-care workers?
As a society, we don't recognize the value of direct-care work: 74%
The government doesn't pay long-term care employers enough to
allow them to pay a living wage: 11%
Employers keep too much of the money they get from the government
and private payers: 15%
Employers spend too much on less important things: 0%
Wages aren't too low; they're about right time: 0%
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Dear Friend
Direct-care worker conferences are always educational and
inspirational, but the Better Jobs Better Care - Pennsylvania
conference early this month was one of the best I've ever been to.
Planned and presented by the direct-care workers on BJBC-PA's
advisory committee, it featured dynamic educational sessions and
plenty of R&R for the attendees, whose busy schedules rarely include
time to unwind. It also created momentum for the professional
association the BJBC-PA worker advisory board has just formed for
Pennsylvania's direct-care workers. (For more information, contact
Karen Reever at
reever@carie.org.) Enthusiasm
for the new group ran high, with every conference attendee who hadn't
already joined signing up on the spot.
The theme of the conference was the power of storytelling to
bring direct-care work to life. Nothing illustrated that point better
than the workshop presented by CNA Linda Buehler and home care aide
Peg Ankney (pictured below), who began by each describing a "typical"
day on the job. Inspired by Linda's and Peg's stories, other
direct-care workers in the audience shared their own, moving the rest
of us to laughter, tears, and even song. To get a taste of that story
sharing session, click on the link in "New in the Clearinghouse" and
read what Peg has to say about her work, in a portrait that ran in
the worker association's Frontline Care newsletter.
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Workforce Strongly Affects Client Satisfaction in Home- and
Community-Based Care
"We found that workforce-related issues are powerful predictors of
client satisfaction with services, taking precedence over other
domains," conclude the authors of "Workforce Issues and Consumer
Satisfaction in Medicaid Personal Assistance Services," a report in
the
fall 2006 issue
of
Health Care Financing Review.
Authors Wayne L. Anderson, Joshua M. Wiener, and Galina Khatutsky
found a particularly strong relationship between consumer
satisfaction and recruitment, or the ability to replace a worker when
needed or deal with unscheduled absences. Problems with retention -
or having a number of different personal assistance workers over time
- did not affect satisfaction as much. "This finding implies," they
conjecture, "that when you count on someone else to meet your
personal assistance needs, having services performed by any number of
different workers is better than having no services at all."
Consumers felt more satisfied if they believed that their workers
were well trained and competent. "In this study," the authors write,
"having well-trained workers was valued as much as having no
recruitment problems." Mistreatment by workers was not much of a
factor in consumer satisfaction, with only 5 percent of the
respondents reporting that they had ever been mistreated and most of
those saying the incidents happened infrequently.
Strengthening the workforce by "[m]aking it easier to find
replacement workers, having workers show up on time, reducing worker
turnover, increasing worker training, and insisting that workers
treat consumers with respect and not mistreat them," the authors
conclude, would significantly improve consumer satisfaction with home
and community-based services.
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Researchers Call for Renewed Focus on Reducing Staff Turnover
Finding that staff turnover negatively impacts staffing levels in
nursing homes,
"Effect of Staff Turnover on Staffing: A closer look at registered nurses, licensed vocational nurses, and certified nursing assistants"
argues that more research and policy needs to be devoted to reducing
turnover, not just implementing staffing level requirements. "Because
public policy has yet to achieve adequate staffing levels and lower
turnover rates," argues the article, "it is important to explore
methods other than staffing standards to address the question."
The traditional assumption has been that low staffing levels
result in an overburdened staff and poor quality, which in turn lead
to increased staff turnover and more vacancies, but the authors
assume that "staff turnover affects staffing levels rather than only
the reverse."
The article, published in the October 2006 issue of
The Gerontologist, looks at causes for turnover among both
nurses and certified nursing assistants (CNAs) and finds that a
significant relationship exists between CNA wages and turnover rates.
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Assisted Living Study Finds Satisfied Staff Leads to Satisfied
Residents
A study published in the October 2006 issue of
The Gerontologist found that assisted living residents are
significantly more satisfied with their care in facilities where
staff are more satisfied with their jobs and have more positive views
of the organizational culture, such as teamwork and participatory
decision-making.
Based on a sample of 335 residents and 298 staff members,
"Linking Resident Satisfaction to Staff Perceptions of the Work Environment in Assisted Living: A Multilevel Analysis"
found no relationship between resident satisfaction and the level of
staff organizational commitment.
"The study findings have practical implications for
administrators and policy makers who are interested in increasing
resident satisfaction with assisted living," concludes author
Elzbieta Sikorska-Simmons. "Because resident satisfaction is related
to staff perceptions of the work environment, efforts to increase
resident satisfaction should also focus on improving the quality of
the work environment for staff."
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Inadequate Staffing Said to Force Residents Out of Assisted Living
A recent article in the
Journal of Gerontological Nursing argues that inadequate
staffing and training force many residents to leave assisted living
facilities for more costly nursing homes, where there is less
independence.
Assisted living facilities, currently serving approximately 1
million older disabled persons, is the most rapidly expanding type or
residential care setting for older people needing long-term care
services. Noting that one third of assisted living residents are
discharged annually to nursing homes or hospitals,
"Providing Quality Care in Assisted Living Facilities: Recommendations for Enhanced Staffing and Training"
argues that relocating people to nursing homes because services are
not available in assisted living facilities is inconsistent with the
principle of aging in place.
The article looks at staffing across different types and sizes of
assisted living facilities, as well as regulations governing the
training of their direct-care workers. Only 19 states specify a
minimum number of hours. On average, assisted living facilities
provide their employees with 19 hours of training a year.
Authors Meridean L. Maas and Kathleen C. Buckwalter provide their
own algorithms for determining how many personal care assistants and
nurses are needed in assisted living based on the number of residents
and their level of need.
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Online Presentation Urges WIBs to Work with Long-Term Care Employers
A web-based seminar aimed at helping members of the workforce
development community understand why focusing on the long-term care
workforce will benefit both the workforce system and long-term care
employers is now available online.
Conducted on October 23 and uploaded the following day, the
webinar featured Scott Sheely and Deb Miller, workforce system
directors who have launched successful long-term care partnerships;
Catherine Wisnoski-Broyles of Sun Healthcare Group; and Dorie Seavey
of the Paraprofessional Healthcare Institute (pictured below), the
author of an
issue brief
on how workforce investment boards and long-term care employers can
work together to strengthen the direct-care workforce.
In her introduction, moderator Gina King of the U.S. Department
of Labor Employment and Training Administration explains why DOL ETA
is supporting greater involvement of the workforce investment system
with long-term care. Roughly 150 workforce development specialists
from around the country participated, most with ties to local or
state workforce investment boards (WIBs).
To listen to the webinar, go to
www.workforce3one.org
and click on Workforce Investment System under Communities. Then
click on Building a 21st Century Long-Term Care Workforce under
Getting Your Skills in Gear. Free registration required.
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Maine Paper Recommends Ways of Strengthening the Direct-Care
Workforce...
A paper from the University of New England's White Paper series warns
of a looming shortage of health care workers and recommends seven
things that can be done to strengthen the caregiving workforce.
Solutions for Maine Health Careers Recruitment & Retention: A visionary approach
describes the demographic trends leading to a workforce crisis and
recommends the following to stave it off:
Centralize access to health professions information
Increase efforts to recruit youth into health careers
Increase efforts to recruit non-traditional populations to
health care
Broaden access to health careers education funding for
individuals
Encourage strategic policy changes
Work to increase federal and foundation support for health
care professions education, recruitment and retention by using
existing resources.
Enlist and proactively work with and through various media to
develop an engaging, informative, and realistic understanding of
health and health care professions, particularly for youth.
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... While Grassroots Group Plans to Pitch In
A grassroots community organization in central Maine voted
unanimously at a recent meeting to help alleviate the growing
shortage of qualified workers by supporting both caregivers and
consumers through "education, awareness, and cooperative efforts" and
by working to improve care by providing direct-care workers with
better compensation and more respect.
According to
"A Crisis of Caring,"
a report published in the November 6 Kennebec Journal, the
Kennebec Valley Organization is a collection of religious
congregations, local labor unions, and community groups that was
founded last year. The group has held roundtable discussions with
"more than 100 people who have been affected by the direct-care
crisis," including consumers, their family members, and direct-care
workers.
Lisa Pohlmann, associate director of the Maine Center for
Economic Policy and the meeting's keynote speaker, thanked the group,
saying: "KVO really seems to us to be the first grassroots effort ...
to take on this issue."
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Demographic Studies Describe DCWs
Two new reports from the Center for Health Workforce Studies at the
University of Albany's School of Public Health include basic data
describing direct-care workers.
The United States Health Workforce Profile
lists the number of home health aides and nursing aides, orderlies
and attendants by state as of 2004. The information about direct-care
workers can be found on pages 117, 118, 150, and 151.
The Impact of the Aging Population on the Health Workforce in the United States: Summary of Key Findings
reports on the number and distribution across settings of nursing
assistants and home health aides nationwide as of 2000. It also
provides some demographic data on nursing assistants.
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New Website, Newsletters Help Spread the Word
A new
web page
for the Maine Direct Care Worker Coalition links to all its members
and to papers and other resources for those interested in improving
working conditions for the state's direct-care workforce. The
coalition's mission is "to promote policy and practices that respect
and value direct care workers in order to sustain quality direct care
in Maine."
A free quarterly newsletter from the
Centers for Medicare and Medicaid Services
(CMS)'s Direct Service Workforce Resource Center provides resources
and information for state Medicaid staff and others working to
address the growing shortage of direct-care workers in home- and
community-based services. The first issue includes information about
how to apply
for the intensive technical assistance available to up to five state
Medicaid agencies to help them develop or implement ways of
strengthening the home- and community-based workforce supporting
people with disabilities.
Click here
to subscribe, or to read the first issue.
Connections@CDS, a free quarterly newsletter from the
College of Direct Support, will carry news of the CDS and its
partners and staff.
Click here
to read the first issue.
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November 30- December 1, 2006
2006 CEAL Quality Summit: Assisted Living: The Next Generation
Opportunities and Challenges, Arlington, VT
December 15, 2006
Massachusetts Day in Iowa...Getting Serious About Health Care Reform
in Iowa, Des Moines, IA
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