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October 31, 2006
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In This Issue:
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Training Materials Roundup
The
National Clearinghouse on the Direct Care Workforce
has compiled a list of curricula, textbooks, and practical guides for
use in training direct-care workers and their supervisors. The
list
is broken down into four categories: entry-level training; skills
enhancement/career advancement; supervision and management; and
consumer-directed care.
Some of the materials listed are curricula, intended for planning
and implementing full trainings. Others are textbooks and guides,
which would likely serve as a component of a training program. A
number of the curricula and texts are the result of publicly funded
initiatives and therefore available at no cost, but most of the
materials listed must be purchased from their publishers. By no means
exhaustive, the list is meant to provide a starting point for
workers, supervisors, and trainers looking for material. Please send
suggested additions to
hthier@paraprofessional.org.
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The Cost of Care
Metlife's annual study of private home care and nursing home costs
finds that home care agencies were paid between $12 (in Shreveport,
Louisiana) and $26 (in Rochester, Minnesota) for an hour of home
health aide time.
The MetLife Market Survey of Nursing Home & Homecare Costs
charts the average, high, and low costs of an hour of home health
aide care time and of a day of nursing home care, in both a private
and a semiprivate room. In most states, it reports costs for at least
two regions.
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Alzheimer's from the Inside Out
A powerful and poignant portrait of Alzheimer's from the inside out
was on display recently in New York City. As reported in the
New York Times,
William Utermohlen, an American artist in London, decided to
chronicle his journey with a series of self-portraits after his
diagnosis of Alzheimer's. "The paintings starkly reveal the artist's
descent into dementia, as his world began to tilt, perspectives
flattened and details melted away," the paper said. "His wife and his
doctors said he seemed aware at times that technical flaws had crept
into his work, but he could not figure out how to correct them."
Photos of some of the portraits accompany the article, which is
available to subscribers free of charge and to nonsubscribers for a
fee.
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Create a statewide, regional, or local pool of pre-screened on-call
emergency workers: 78%
Require agencies to respond quickly and effectively when alerted
to gaps in service: 11%
Require agencies to use information technology to identify and
quickly respond to worker absences: 0%
Create registries of pre-screened workers that identify those
available to provide emergency backup: 0%
Pay backup workers a premium and reimburse them for their travel
time: 11%
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Dear Friend
The winds that are blowing the new weather our way seem to be
sweeping in a lot of other changes too: The next time I write to you,
we'll have elected a whole new set of representatives in the midterm
election.
Don't forget to vote! May the best women and men win.
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Two Fact Sheets Outline Health Care Crisis in Pennsylvania and
Michigan, Point to Solutions
Arguing that "quality long-term care depends on healthy direct-care
workers," two fact sheets provide information about why many
direct-care workers in Pennsylvania and Michigan lack health
insurance. They also explain why that matters -- not just to workers
and their families but to long-term care consumers, employers, and
taxpayers.
The fact sheets from Health Care for Health Care Workers, both
titled Caregivers Without Healthcare, note that the states'
direct-care workers average about $10 an hour and are often employed
part-time, putting insurance out of reach for many. The fact sheets
direct readers to information on models for making insurance
available and affordable to workers. Click
here
for the Michigan fact sheet and
here
for the Pennsylvania fact sheet.
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Circle of Care Joins Circle of Worker-Owned Co-ops
Circle of Care, a new
home care and personal care cooperative, finds that worker ownership
helps create a satisfied workforce and a growing clientele.
Serving Northeast Wisconsin, the Appleton-based co-op is the
newest addition to a small but growing movement of cooperatively
owned home care and home health agencies. Cooperatives are businesses
owned and democratically controlled by their members.
Home Care Cooperatives: Worker Ownership in Focus
explains that though worker cooperatives have existed for about 150
years in the U.S., the first worker-owned home care cooperative
emerged in 1985. At present, there are a handful of home care
cooperatives around the country, which seek to empower their
worker-owners to deliver high-quality care.
Click
here
for the rest of the story.
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Vermont Pays Family Members to Expand Home Care Workforce
A front-page article in the October 23
Wall Street Journal describes "an unusual Vermont experiment"
in which, as part of its effort to pay for less nursing home care and
more home care, the government is paying family members about $10 an
hour to care for their aging relatives. "We are never going to build
another nursing home," the article quotes Patrick Flood, commissioner
of Vermont's Department of Disabilities, Aging and Independent
Living, as saying. "It is an outdated model."
Seniors in Vermont are Finding They Can Go Home Again
notes that home care jobs are often held by "minority or immigrant
women who earn as little as $6 to $8 an hour." In Vermont, however,
the level of education is high and people tend to leave the state for
higher-paying jobs. "There is a severe shortage of caregivers, so
hiring relatives can be ideal." The state wants to start paying
spouses to be caregivers, the article notes, although current
Medicaid rules do not allow it.
The article is available to subscribers free of charge and to
nonsubscribers for a fee.
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Inadequate Reimbursement Causes Maine Labor Pool to Shrink, says Paper
"Only one thing is more alarming than the government's chronic
under-funding and the growing number of Maine people requiring elder
care services. That is the shrinking pool of skilled workers who
provide the care," says a white paper by the Maine Health Care
Association.
An Opportunity to Respect Our Elders
calls the shortage of workers "the most significant barrier to
providing quality elder care in Maine," adding that "The available
labor pool is shrinking as the demand for services reaches critical
proportions."
The paper links workers' low wages to Medicaid payments that
"generally fall far short of covering actual labor costs."
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Florida Nursing Homes Struggle to Comply with Staffing Requirements
A shortage of nursing assistants is making it extremely difficult for
nursing homes in Southwest Florida to comply with state staffing
requirements, according to the Florida Health Care Association.
"Statewide nursing assistant shortage hits home",
a story in the Oct. 14 Naples News, says the association
found a particularly acute shortage in Collier County, an urban
county that includes Naples. There is one CNA for every 25 residents
age 65 or older in Collier, the association found, in comparison to a
state average of one CNA for every 9 elders. "At the same time," the
story says, "the high cost of housing in Collier makes it nearly
impossible for CNAs to get by."
Florida is increasing the number of hours of CNA care per
resident day required in nursing homes, in accordance with a nursing
reform bill passed in 2001. As of next January, homes will be
required to provide 2.9 hours, up from 1.7 hours in 2001.
The association estimates that the boosted standard will require
nursing homes to hire 3,000 more CNAs. Many homes are already
offering inducements for current staff in other departments who want
to become CNAs, the article says.
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Getting an "Invisible" Workforce Its Due
An article in March 2006 issue of Politics & Society looks at
"the social struggles that forced the state to recognize its
invisible workforce" in California and Oregon as workers, consumers,
union organizers, and state policymakers all worked to upgrade the
status of home care aides.
"Organizing home care: Low-waged workers in the welfare state"
also discusses how "the welfare nexus, linking old age, disability,
health, and welfare policies," transformed care that had been done
privately in the home and for no compensation into a public service.
Available to subscribers free of charge and to nonsubscribers for
$25.
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Report Considers Role of Direct-Care Staff in Improving Long-Term Care
Out of the Shadows: Envisioning a brighter future for long-term care in America,
a report by Brown University's Edward Alan Miller and Vincent Mor,
includes a detailed and thoughtful chapter on the care gap and how to
narrow it.
Titled "Investing in the Long-Term Care Workforce," the chapter
includes demographics of the direct-care workforce and discussions of
the link between staff levels and care quality, recruitment and
retention challenges, the role that low wages and poor benefits play
in keeping turnover rates high, and the importance of adequate
training and career advancement opportunities.
The report was conducted for the
National Commission for Quality Long-Term Care.
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On the Eve of Graduation, BJBC Gets Good Grades...
The "proudest achievement" of the four-year Better Jobs Better Care
(BJBC) research and demonstration project that is now winding to a
close is North Carolina's new special licensure designation for
nursing homes, the New Organizational Vision Award (NOVA), according
to an article about the program in the October 16 issue of
McKnight's Long Term Care News. BJBC's creators hope that
NOVA, which rewards facilities for attracting and keeping frontline
staff, will become a model for other states.
Meanwhile, the article says, BJBC has many other notable
achievements to celebrate. The project has made "a strong, lasting
impression" on participating providers and "created a knowledge base
that facilities and the industry will be able to draw from for years
to come," according to the McKnight article, "Grant program explores
workplace practices to improve retention among frontline staff."
The article
says lessons learned by project participants include "the importance
of policy and practice to cause change; the role of coalition
building in implementing initiatives; and the impact of involving
direct care workers in a facility's decision-making process."
The program, which is funded by the Robert Wood Johnson
Foundation and Atlantic Philanthropies, will end on December 31.
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... While RWJ Starts Up the Next One
Nine projects have been awarded grants through
Jobs to Careers: Promoting Work-Based Learning for Quality Care,
a new national initiative to advance and reward skill development
and career advancement by frontline workers.
The four-year, $15.3 million national initiative is funded by the
Robert Wood Johnson Foundation and the Hitachi Foundation. The nine
projects will expand and redesign systems to create lasting
improvements in how institutions train and advance frontline workers
employed in entry-level positions such as dietary aide, substance
abuse worker, medical assistants housekeeper, clerk, or patient care
technician. The program will provide them with training and
opportunities to enable them to gain jobs with better pay and
increased responsibilities.
Grantees include Asante Health Systems of Medford, Oregon; the
Baltimore Alliance of Baltimore, Maryland; District 1199C Training &
Upgrade Fund in Philadelphia; Northern Arizona University; Owensboro
Community & Technical College in Kentucky; Portland Community College
in Oregon; SSTAR of Fall River, Massachusetts; Waianae Health System
in Hawaii; and WorkSource Austin in Texas.
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Massachusetts Career Ladder Program May Have Had Positive Effect on
Residents
An issue brief summarizing an evaluation of a career ladder
initiative in Massachusetts aimed at reducing high turnover and
vacancy rates among nursing assistants in nursing homes found that it
may have achieved its goal. However, it was not clear how many of the
positive changes were due to the initiative and how many to other
factors.
Effects
of the Massachusetts Extended Care Career Ladder Initiative (ECCLI)
on Quality of Care Outcomes for Nursing Home Residents
reports on a study of 450 homes. The researchers evaluated
ECCLI's effects on residents by studying data from the minimum data
set (MDS).
The researchers found some improvements in residents and improved
relationships between residents and workers in the ECCLI homes.
However, they also observed favorable changes in homes that did not
participate in ECCLI - perhaps, they hypothesize, because of changes
in reimbursement or care practices resulting from the National
Nursing Home Quality Initiative and/or changes in reimbursement.
"The researchers concluded that ECCLI participation may improve
the quality of care for nursing home residents, and, consequently,
improve their quality of life," the issue brief says. "More research
is needed to better characterize the difference between facilities
that participate in ECCLI and those that do not, to clarify and
codify the content of ECCLI programming, evaluate the effects over a
longer period of time after training, and to better characterize
changes un-related to ECCLI in the nursing home environment."
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November 5-8, 2006
American Association of Homes and Services for the Aging (AAHSA) 2006
Annual Meeting and Exposition, San Francisco, CA
November 6-7, 2006
11th Annual Edna Gates Conference on Alzheimer's Care, Troy, MI
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