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July 11, 2006
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In This Issue:
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Differentiating Between Cultural and Programmatic Change
The growth of the "culture change" movement-the effort to transform
long-term care institutions into communities where elders and workers
thrive-has led to new challenges in distinguishing between genuine
cultural change and programmatic, or surface, change. According to an
article in the 2005 issue of the
Journal of Social Work in Long-Term Care, the espoused values
of an organization often don't line up with their values in action,
or actual workforce and caregiving practices.
In
"Changing the Culture of Long-Term Care: Moving Beyond Programmatic Change",
authors Susan Misiorski and Karen Kahn argue that while new programs
may represent changes in an organization's procedures, the values of
the organization do not always change. For example, an institution
working to improve mealtimes for residents may add a breakfast buffet
or rolling steam tables, but without involving workers and residents
in the decision-making, these changes don't address the real needs of
elders. The authors point to a positive model, which would involve
residents and staff at all levels in creating a dining experience
"with the explicit goals of creating home, maximizing personal
choice, and building relationships/community." They conclude that "in
the end, programs come and go, but cultures live on."
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Self-Directed Care for Medicaid Beneficiaries Gains Popularity
Nearly all states have or are planning some form of self-managed or
self-directed care for Medicaid beneficiaries, according to a report
from the Kaiser Family Foundation and the Kaiser Commission on
Medicaid and the Uninsured.
Beyond Cash and Counseling: An Inventory of Individual Budget-based Community Long Term Care Programs for the Elderly
finds that 22 states have such programs in place or are actively
planning them. It also finds that 14 states and the District of
Columbia have or are planning programs with some degree of consumer
direction that include the elderly, and another 13 have or are
planning such programs that do not include the elderly.
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Running the Numbers
The Congressional Budget Office's estimate of the cost of providing
personal assistance services to low-income people with disabilities
was high enough to stall proposed federal legislation, but that
estimate may be way off base. An
article
in USCFToday, a publication of the University of California,
San Francisco, explains how the CBO arrived at its figure of $10 to
$20 billion a year and outlines an alternative - and much lower -
estimate of the cost. Using the same data but basing their
calculations on different assumptions about eligibility and need,
UCSF School of Nursing researchers Mitchell LaPlante, Steve Kaye and
Charlene Harrington estimate the likely cost to be $1.2 billion to
$3.2 billion. "Their study not only challenges the CBO's assumptions,
but raises the question of just how people arrive at numbers that
become gospel in public discussions," writes Andrew Schwartz in the
UCSF publication.
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Webinars to Explain Training Grants
Community and technical colleges, community college districts, state
community college systems, one-stop career centers, and other
educational entities may want to participate in a webinar later this
month to learn more about a new federal grant. The Employment and
Training Administration of the U.S. Department of Labor is making
approximately $125 million available for
Community-Based Job Training Grants.
The grants will be awarded to organizations that support or engage
in a combination of capacity building and training activities to
provide training for careers in high-growth/high-demand industries,
which include direct-care jobs in long-term care. Registration for
the 150-minute webinars is limited.
Click here
to learn more about the July 20 webinar,
here
for July 21, and
here
for July 25.
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Dear Friend
The Paraprofessional Healthcare Institute is in hiring mode
again. For those who don't know, PHI is the parent company of the
National Clearinghouse on the Direct Care Workforce, which publishes
this newsletter. The openings are for:
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Executive director
of a new training and support center for direct-care workers;
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Director of evaluation
for PHI; and
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Campaign coordinator
for PHI's Health Care for Health Care Workers campaign.
Meanwhile, the
Direct Care Alliance,
a former PHI initiative which recently became an independent
501(c)(3) organization, just welcomed a new executive director.
Leonila Vega, a lawyer with experience in benefits, long-term care,
disability, and elder rights, was director of the Home Care,
Political program for the Service Employees International Union Local
150 before joining the DCA. She will work out of PHI's office in the
South Bronx.
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CMS to Help Five States Strengthen the Home- and Community-Based
Workforce
The Centers for Medicare & Medicaid Services has chosen five state
Medicaid agencies to receive intensive technical assistance (TA) from
CMS' National Direct Service Workforce Resource Center. The TA will
help the states develop or implement ways of strengthening the
workforce that supports people with disabilities in home and
community based settings, according to an
announcement
on the CMS website
The five states are:
- Arizona, which will establish a foundation for
consumer-directed care and for reimbursing spousal caregivers;
- Louisiana, which will implement a workforce development
initiative that includes improving wages and benefits, developing
recruitment programs, expanding career pathways, and finding ways to
address an immediate shortage of direct-service workers in areas
affected by Hurricane Katrina;
- New York, which seeks assistance for three parts of an ongoing
project to strengthen its direct-support workforce: training, career
development, and supporting workers who assist self-directing
consumers;
- South Carolina, which is developing educational interventions
for managers and supervisors in an effort to improve retention rates
for direct-service workers; and
- Texas, which is looking for ways to reduce turnover, improve
the perceived professional status of direct service workers in the
community, and improve outreach and education for workers who serve
people who have recently relocated from institutions into the
community.
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Maine Bills Call for Raising Wages for State-Funded Direct-Care
Workers
In late June, Maine Governor John Baldacci signed
LD 1991,
a bill to raise wages for personal care assistants who provide
services under the state's consumer-directed personal care program.
The bill proposes that their pay increase from $7.71 to $10 an hour
by next January, but the plan must be approved by the federal
government.
Another new law in Maine requires the state's Department of
Health and Human Services to look into what it would cost to pay a
starting wage of $10 an hour and provide health coverage for all
direct-care workers in state-funded and Medicaid-funded long-term
care programs.
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QIO Says Consistent Assignments Improve Care Quality, Reduce Turnover
Consistent assignments, or the practice of ensuring that caregivers
assist the same group of residents on at least 85 percent of their
shifts, improves care quality and reduces turnover, according to an
article in Provider magazine's June issue, yet all but about
10 percent of the nation's nursing homes rotate caregivers throughout
the facility instead.
In
"A Case for Consistent Assignment,"
author David Farrell and colleagues from Quality Partners of Rhode
Island and B&F Consulting describe the results of a one-year
"Improving Nursing Home Culture" pilot program recently funded by the
Centers for Medicare & Medicaid Services. That study and others, they
say, "cite evidence for consistent assignment as foundation for
quality improvement."
The authors say long-term care managers have many reasons for
rotating staff, including a desire to prevent burnout, a desire for
all staff to be somewhat familiar with the needs of all patients. But
their actions, however well-meaning, have a negative effect. "In long
term care," the authors write, "the work has inherent meaning for
people attracted to caring for others. Yet management systems such as
rotating assignment can interfere with, rather than support, the
caring connection with patients that often draws individuals to
caregiving work in the first place."
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NAGNA Takes New Name, Financial Status
The organization formerly known as the National Association of
Geriatric Nursing Assistants (NAGNA) is now the
National Association of Health Care Assistants
(NAHCA). The name change represents an effort to "expand our mission
and open our association to all frontline care providers regardless
of their care specialties," according to a NAHCA news release.
In addition, the organization has become part of the Academy of
Certified Health Professionals, a 501(c)(3) organization formed last
year by NAHCA cofounders Lori Porter and Lisa Cantrell, in order to
qualify for grants and other funding.
As chief operating office and president, Porter and Cantrell are
responsible for the daily operations of the academy and NAHCA. The
academy also has a board of directors, and the association has a
steering committee composed of 11 nursing assistants from different
states. One member of the steering committee also holds a seat on the
academy's board of directors.
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The Virtues of Vigilance
In the June issue of
Nursing Homes/Long Term Care Management,
faculty and staff of the Borun Center for Gerontological Research
recommend what they call "a mundane exercise but sometimes an
eye-opening experience" to improve care quality and enhance quality
of life in nursing homes: direct observation of caregiving staff.
"Some, but not all, daily care routines are both feasible for
supervisors to observe and worth the time it takes to scrutinize
them. Facilities should be selective about this," the authors note in
"Improve Quality? Watch What Staff is Doing." Since the mere presence
of the supervisor who is doing the observing is likely to alter the
situation being observed, they recommend that observers be as
unobtrusive as possible and let staff know in advance that the
purpose of the exercise is to not to entrap them but to see whether
"particular residents who need or want a certain service are
receiving it." They also recommend creating a checklist for each of
the activities being observed, to ensure that all observers are
looking for the same things.
The article includes a link to the
Borun Center website,
which includes six training modules on improving daily care in
nursing homes. The module on preventing weight loss includes a
mealtime observation form.
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Project Developing National Curriculum for Caregivers
As part of a new project aimed at improving care quality for older
adults, an Arkansas philanthropist is funding an attempt to develop a
national curriculum for direct caregivers in long-term care.
The Schmieding Foundation of Springdale, Arkansas, launched the
three-year project with a million-dollar challenge grant. It is
funding the
International Longevity Center-USA
(ILC-USA) and the
Schmieding Center for Senior Health and Education
(SCSHE) in a joint venture intended to "bring greater awareness of
the caregiving crisis, develop a national systemic approach to
recruiting, training and retaining paid professional caregivers, and
enhance the key role of this new generation of caregivers," according
to a
news release
issued by the ILC-USA. The project also aims to raise national
awareness of the caregiving crisis, create a set of standards for
caregivers and those supervising them, and eventually to create a
national organization for caregivers.
SCSHE Director Larry Wright and his staff have already pioneered
curricula and other educational materials for both family and
professional caregivers in northwest Arkansas. "This project allows
us to take our work to a national level as we collaborate with our
colleagues at the ILC-USA," says Wright. "What we really need is
respect for the caregiver and a career ladder that makes this a
valued profession for those who devote themselves to the care of
others."
According to the news release, Lawrence H. Schmieding is an
agribusiness leader and benefactor to the SCSHE who has championed
better caregiving services for elders ever since his older brother
became ill.
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July 18, 2006
Vermont Association of Professional Care Providers meeting and
Continental breakfast, Burlington, VT
September 11, 2006 - September 12, 2006
Iowa CareGivers Association Annual Conference, West Des Moines, IA
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