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December 14, 2007
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In This Issue:
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Recent additions
Click here to see what's new in the Clearinghouse.
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The Co-Payments Are Too High
"I've been a nurse's aide ever since I started working," says Mary Jane Bourdess, a Pennsylvania home health aide. "For the past eight years I've been with the same home health care company, but I've only been insured for three years. You have to be working full-time - at least 35 hours a week - to qualify, and it was hard to get that many hours. Even now, with insurance, I don't get prescriptions much because the co-payments are high."
Mary Jane's story
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Maine Bill is Amended, Moved to New Committee
To help keep Maine's LD 1687 alive, the Direct Care Worker Coalition took out a costly clause. The coalition also moved the bill from the Health and Human Services (HHS) Committee to the Insurance and Financial Services Committee, where it will be heard in the session that begins next month.
LD 1687 would extend health insurance to more Maine workers.
Details
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More Information
Click here to read more from and about the HCHCW campaign.
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Online Resources for LTC Consumers and the People who Assist Them
The federal government has launched several new online resources aimed at helping older adults or people with disabilities and those who assist them:
- The National Center on Elder Abuse is a resource center dedicated to the prevention of elder mistreatment.
- A free toolkit for teaching older adults how to find reliable health information online is available on the National Institutes of Health website.
- The U.S. Department of Health and Human Services has released a health literacy tool for people who serve older adults. It bridges the communications gap between elders and health care professionals.
- Managed by the U.S. Department of Labor's Office of Disability Employment Policy, DisabilityInfo.gov offers elders and people with disabilities access to information and resources that allows them to fully participate in the workforce and in the community. It also provides support for caregivers.
- A Spanish-language guide from the Agency for Healthcare Research and Quality helps patients understand the latest scientific evidence on osteoarthritis pain relievers. The guide, along with a previously released English version, is available in both printed and electronic formats.
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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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Which of the following is NOT recommended by the Caregivers are Professionals, Too! report?
The correct answer (and the one 50% of you chose):
Guarantee all direct-care workers at least $10 an hour
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Dear Friend,
If you're reading this newsletter, you probably like to know what research can tell us about life. If you also love the way good fiction can distill certain truths, you might want to check out three movies about life in long-term care facilities that came out this year.
The stories, characters, and settings in Away From Her, The Savages, and The Diving Bell and the Butterfly are as different from each other as cheese and chalk, but all three are stuffed with beautifully observed details. Like the lack of privacy that colors life even in the best of institutions, the holiday decorations that can make a nursing home look like a kindergarten, and -- over and over again -- the kindness and generosity of good caregivers. In these movies as in life, direct-care workers meet residents wherever they may be, cushioning their emotional free-falls as they adjust to a new stage of life.
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Building on What We Know: Constance Coogle and Iris Parham
"There needs to be a real shift in terms of the values of our society, in how we regard the people who give this care," says Constance L. (Connie) Coogle, Ph.D., (pictured here) of our nation's direct-care workers. "How do you get a whole society to have a revolutionary change of values?
"I think maybe you do it the way we've been doing it: Start at the ground level and get the supervisors, the administrators, the families, everyone who's directly connected to see the value of what's being provided. Then gather the data to make the case for better quality care. That's when the policy pieces start to change."
Click here for more from Coogle and her colleague Iris Parham, Ph.D.
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Industry Experts Warn of Staffing Problems in Nursing Homes
Three industry events last Friday -- a press briefing by the Alliance for Health Reform, a survey of consumers by the Kaiser Family Foundation, and a news release from the Alliance for Quality Nursing Home Care -- all pointed to staffing as a serious issue in nursing homes.
At the Washington, D.C. briefing, which was held to honor the 20th anniversary of the Nursing Home Reform Law, panelists Christine Williams and Ruth Katz both discussed staffing shortage. The question of setting minimum standards, they noted, continues to perplex the nursing home industry. Kaiser's study, released on December 7 to mark the same anniversary, found that consumers believe staffing to be a problem at nursing homes. Sixty percent of the survey respondents said they thought staff are poorly trained, and seventy-five percent don't believe that facilities are adequately staffed.
Meanwhile, an Alliance for Quality Nursing Home Care news release responded to a Medicare Payment Advisory Commission (MedPAC) draft recommendation. MedPAC recommended against skilled nursing facilities receiving an increase in Medicare reimbursement for 2009. The alliance countered that Medicare payments must be high enough to offset too-low Medicaid rates. Otherwise, it warned, "With as much as 70% of nursing home operating costs driven by labor costs, inadequate overall funding may force nursing homes to make difficult decisions that could affect the hundreds of thousands of direct-care workers in nursing homes."
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Government Urged to Push for Better Pay, Working Conditions
The federal government should encourage more caregivers to enter and remain in the field of long-term care, according to a report from the National Commission for Quality Long-Term Care. It should also push for better pay, working conditions, training and opportunities for advancement.
The bipartisan commission is chaired by former U.S. Senator Bob Kerrey (D-NE) and former House Speaker Newt Gingrich (R-GA). Its report, issued on December 3, urged Congress and the presidential candidates to make long-term care a higher national priority. At a press conference announcing the report, Senator Kerrey said he was surprised and disappointed that none of the presidential candidates has said much about long-term care and called upon the next president to include it in his or her first State of the Union address.
From Isolation to Integration: Recommendations to Improve Quality in Long-term Care makes recommendations in three key areas: workforce, care quality, and information technology. It also provides a "framework and general principles" to address long-term care financing.
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Judge says California State Officials Fail to Comply with Staffing Laws
According to the Sacramento Bee, California state officials are not complying with laws mandating minimum nursing home staffing requirements.
A state law passed eight years ago said nursing homes must provide an average of at least 3.2 nursing hours per patient day. But in a recent ruling on a lawsuit brought by a former nursing home resident, a Sacramento Superior Court judge said the state failed to write the required regulations outlining how skilled nursing facilities were to fulfill that mandate. According to briefs filed in the case, that failure "left many questions unanswered, such as whether dietary, social service and other activities should count in calculating nursing hours." The judge dismissed the lawsuit, saying it was asking the courts to "resolve disputes that should have been resolved by the timely enactment of regulations."
Meanwhile, California health officials have proposed replacing the current minimum with minimum staff-to-patient ratios. According to the article, legislation passed six years ago ordered health officials to issue staff-to-patient ratios by August 2003, but they have not done so yet.
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Recent Reports
National Validation Study of Competencies for Frontline Supervisors and Direct Support Professionals. This study by Sheryl Larson and colleagues builds on earlier work by the University of Minnesota's Research and Training Center on Community Living to look at the workplace competencies needed by direct support professionals and their supervisors.
"Supervisory Support, Job Stress, and Job Satisfaction among Long-term Care Nursing Staff." "Administrators of LTC facilities must develop strategies to enhance the supervisory skill of registered staff, thereby increasing work satisfaction of NAs," concludes this research report in the July/August 2007 issue of the Journal of Nursing Administration.
"The Underreporting Gap in Aggressive Incidents from Geriatric Patients Against Certified Nursing Assistants." Published in Violence and Victims, Vol 22 #3, this study examines the startlingly high rate at which CNAs in geriatric care facilities are assaulted by the people they assist -- and the reasons why 95 percent of the incidents were not reported to the facilities. It also looks at the relationship between experiencing aggression from residents and organizational commitment, job satisfaction, and intent to leave the job.
A report conducted for South Dakota found that the state's demand for long-term care services is outpacing the supply of workers, thanks to a booming population of elders and a wave of migration from small towns to cities. An article in The Argus Leader about the Abt Associates report says there is also a shortage of nursing homes and assisted living facilities in the more populated parts of the state.
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Back Supports Reduce Repeated Episodes of Pain
A study on gait belts and other supports often used by direct-care workers to prevent or treat lower back pain finds that they do not prevent first episodes of back pain, but they may help to prevent repeated episodes.
"Lumbar Supports to Prevent Recurrent Low Back Pain among Home Care Workers:
A Randomized Trial," which studied 360 home care workers in the Netherlands, found that workers with the back supports reported an average of 53 fewer days with low back pain over the course of a year than those who worked without them. The study was published in the November 20 issue of the Annals of Internal Medicine.
Full article (free to subscribers only; others must pay)
Free plain-language summary
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Home Care Aide Wages Get Worse in Ontario
A media advisory from Service Employees International Union Local 1 in Toronto quotes Local 1 President Sharleen Stewart's warning to the Ontario government: "The cycle of poverty is gaining momentum in Ontario, and it is the Government of Ontario that has set it in motion," she said at a November 29 poverty rally.
According to Home Care Workers Know Poverty First Hand, a new process of competitive bidding awards home care contracts to the agencies that submit the lowest bids. "The result is home care workers in Ontario have no benefits, no pensions, and receive no travel allowance except a mere 26-cent per kilometre for using their own vehicle to travel from client to client," says Stewart.
Furthermore, the advisory says, home care workers are not protected by Ontario's Employment Standards Act, which includes minimum wage and overtime rules. Instead, says Stewart, "They are considered elect-to-work workers, because they theoretically have the right to choose when they work. Who chooses to work at a below poverty level paying job? Especially when you have to have two or three of those jobs just to get by."
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Mechanized Nursing Assistants
Every couple of years, some technology guru decides the answer to the direct-care worker shortage is simple: Robots!
The latest proposal is from RE2, Inc., which calls itself "a leading developer of intelligent modular manipulation systems." Its December 4 press release announced that it has a grant from the U.S. Army's Telemedicine and Advanced Technology Research Center to design a Robotic Nursing Assistant (RNA).
Billed as an answer to the caregiver shortage in hospitals and other clinical workplaces, particularly among RNs, the RNA is intended to "serve as an extension of the nurse when performing physically challenging maneuvers such as helping a patient sit up in bed or moving a patient from a gurney to a hospital bed."
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VA Funding Care for Caregivers
The Department of Veterans Affairs (VA) is providing nearly $4.7 million for assistance with personal care and other "caregiver assistance pilot programs" for the family caregivers who assist disabled and aging veterans in their homes. According to a VA press release, the program will support eight pilot projects nationwide, including a 24-hour in-home respite care program that will relieve family caregivers for up to 14 days a year.
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February 23, 2008
National Association of Workforce Boards (NAWB) Annual Forum
January 27, 2008
The 3nd Annual Private Duty Home Care Leadership Summit
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