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July 28, 2006
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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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One Step Forward, Two Steps Back
When Work Doesn't Pay,
an issue brief from the National Center for Children in Poverty,
illustrates how difficult it can be for low-income working parents to
make progress in the workplace. The brief explains how increasing
earnings can cause families to lose eligibility for government work
supports, leaving them no better off than before. The authors outline
goals and characteristics that should be part of a "comprehensive
work support system."
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CMS Solicits Comments on Medicaid Eligibility Rule
The Centers for Medicare and Medicaid Services (CMS) is soliciting
comment on a
proposed rule
that would require all Medicaid recipients to produce documentation
of identity and U.S. citizenship. The rule, which was called for in
the Deficit Reduction Act (DRA) passed last December, exempts the
approximately 8 million people who receive Medicare or Supplemental
Security Income (SSI) because they have already met certain
documentation requirements. Nonetheless, it could affect eligibility
for many potential Medicaid recipients. Comments are being collected
through August 11.
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Government Websites Promote LTC Awareness for Consumers
The first part of a national clearinghouse for consumers looking for
tools and information to help them plan for long-term care is now
online, and the rest is expected to be operational by the end of
September. The clearinghouse, which was mandated by the DRA, consists
of two components: a National Clearinghouse for Long-Term Care
Information website, which is still in the works, and a
Long-Term Care Awareness Campaign,
which is already up. The clearinghouse will also include information
on Medicaid and state partnership long-term care programs. The
clearinghouse and campaign are a collaboration of CMS, the
Administration on Aging, and the Office of the Assistant Secretary
for Planning and Evaluation with the National Governors Association.
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Dear Friend
Two new jobs have become available at the Paraprofessional
Healthcare Institute, the parent company of Quality Jobs/Quality
Care's publisher, the National Clearinghouse on the Direct Care
Workforce. The latest openings are for a
coaching supervision program associate
and a
business/consulting manager.
For a list of all open positions, go to the
PHI website and scroll down to
Employment.
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Articles Acknowledge Key Role Played by Immigrants in Long-Term Care
Recent features in two major newspapers looked at the opportunities
and challenges that arise from the large number of foreign-born
workers in long-term care's direct-care workforce.
"Who will Care for U.S. Elderly if Border Closes?"
says a Census Bureau survey counted 254,000 foreign-born workers
among a total of 850,000 frontline home-care workers, and that number
"doesn't count many undocumented immigrants caring for people
privately." The article, which appeared in the July 26 Wall Street
Journal, reports that an industry coalition including the American
Health Care Association and the National Association for Home Care is
lobbying for a new visa aimed at admitting 400,000 low-skilled
workers a year. But, it notes, some observers fear that "filling
vacancies with immigrants might depress wages for the lowest paid
workers in the field."
A June 20 article in the
Seattle Times
says immigrants have been "reshaping the face of the long-term-care
industry" in and around that city for about the past 15 years. Some
Seattle nursing homes, it adds, now reports that half their staff is
foreign-born.
Most of the residents, administrators and others quoted said the
diversity that results from immigration strengthens the culture of
their homes and enriches the lives of both residents and staff.
However, the article notes, differences sometimes lead to conflict,
especially when residents and caregivers don't speak the same
language.
Two of the facilities cited address that problem by employing
people who don't speak English well in "positions that don't require
contact with residents, such as laundry, housekeeping or kitchen
services" and making available classes in the English language and
American culture for those who want to move into caregiving
positions.
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Implementing and Funding Workplace Strategies that Work
A number of improvements to workplace conditions for direct-care
workers have led to reduced frontline turnover and other measurable
benefits, according to
Creating Careers, Improving Care: A Win-Win Economic Advancement Strategy for Certified Nursing Assistants in Long-Term Care.
The report, which was published by Jobs for the Future by the
Jacob and Valeria Langeloth Foundation, outlines the challenges
facing long-term care and its direct-care workforce and describes a
number of successful strategies. It also discusses various kinds of
funding available to pay for the costs of workplace improvements and
recommends ways funders can encourage adoption of promising
practices. Investing in career advancement for CNAs, writes author
Heath Prince, serves the common good by raising the wages of
low-income workers and by leading to improvements in the quality of
long-term care. "With a strategic investment in the training and
advancement of the long-term care workforce," he concludes, "the
public can not only avert a health care labor crisis, but at the same
time gain high-quality care."
The practices generally center around improving recruitment
strategies, improving retention rates, and/or providing career
ladders for frontline staff.
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A Look at the Link between Turnover and Tension among Caregiving Staff
An article exploring class dynamics, hierarchies, and tensions among
nursing assistants (NAs) and nurses in a Midwestern nursing home
concludes that these factors contribute heavily to the high turnover
rate among NAs.
While nursing assistants form the vast majority of staff in
nursing homes, they constitute the bottom rung of a multi-tiered
''chain of command,'' comprised of administration, nurse-supervisors,
and aides, according to
"Working in and Around the 'Chain of Command': Power Relations among Nursing Staff in an Urban Nursing Home."
Staff on the top rungs who were interviewed during the study often
regarded NAs as irresponsible and uncommitted, and therefore in need
of strict discipline. Authority was in turn enforced by nurses, who
were responsible for NA supervision. This "chain of command," along
with nurses' own desires to escape stigmas attached to nursing home
work, contributed to animosity among staff. Author Lori Jervis argues
that this dynamic is underpinned by the struggle within the nursing
field to win professional status.
The nursing hierarchy also reflected divisions along lines of
race, class, and gender. While top staff was all white and nurses
were racially mixed, nearly all aides were black women.
Overwhelmingly, NAs felt used and underpaid, and had an "us-them"
attitude towards top staff. They also felt overly disciplined by
nurses, whom they considered to be lazy, hypocritical, and
domineering. Many reacted by ignoring or avoiding supervisors,
carrying out low-level industrial sabotage, or simply quitting their
jobs.
The article was published in the March 2002 issue of
Nursing Inquiry.
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PAS Workforce Needs TLC
The number of personal assistance and home health workers tripled
between 1989 and 2004, according to U.S. survey data analyzed in a
recent report. But low wages, scarce health benefits, and high job
turnover rates "highlight the need for greater attention to ensuring
a stable and well-trained workforce to meet growing demand."
According to
"The Personal Assistance Workforce: Trends in Supply and Demand,"
median hourly wages for personal assistance workers climbed from
$5.41 in 1989 to $8.40 in 2004, increasing by 55.3 percent while
inflation grew by 52.3 percent. During the same period, wages
increased by 78.9 percent for nursing home aides and by 85.5 percent
for people working in entry-level positions at food counters,
cafeterias, and other such establishments. Less than a third (29.4
percent) of personal assistance workers were covered under their own
employment-based health insurance coverage as of 2004. Many were
ineligible for coverage because they did not work full-time.
"Attracting and retaining skilled workers could become
increasingly difficult if job conditions do not improve," write
authors H. Stephen Kaye and colleagues from the University of
California, San Francisco. "A shift in the economy, a reduction in
the scope of government programs, or competition from other
occupations could result in precipitous declines in the personal
assistance work-force. We feel that this occupation must be upgraded
to offer a living wage, stable work hours, health benefits, and job
security. State certification requirements might also ensure that
workers possess adequate training and job skills."
The article, which appeared in the In the July/August issue of
Health Affairs, captured the attention of business news media, with
both Forbes and the Bloomberg news services running articles on its
findings on July 11. "The wages for fast-food restaurants could
overtake those for providing home care, and this is a job that
requires dedication, as opposed to flipping burgers," Kaye told
Bloomberg reporter Kerry Young. "There's a real danger that Medicaid
will make cuts and make the jobs even less stable."
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Both Quantity and Quality of Caregivers Key to Nursing Home Customer
Satisfaction
A new nursing home customer satisfaction survey billed as "by far the
largest and most comprehensive database on resident and family
satisfaction ever assembled" finds respondents more satisfied with
the care provided by individual caregivers than with the number of
caregivers on staff.
The
2005 National Survey of Resident and Family Satisfaction in Nursing Facilities
was conducted for the American Health Care Association (AHCA), which
plans to repeat the survey annually.
Researchers at My InnerView, Inc., which conducts web-based
surveys for healthcare organizations, analyzed responses from 70,966
surveys completed online by nursing home residents and family members
in 50 states and the District of Columbia. Eleven percent of the
respondents were residents and the rest were relatives of residents -
usually adult children.
About three-quarters (77.6 percent) rated overall quality of care
either "good" or "excellent." The ratings were slightly higher for
nursing assistant care, which was one of the components of that
total, with 33.7 percent rating it excellent and 44.6 percent good
(another 17.1 percent called it fair, and 4.6 percent rated it as
poor.) Staff adequacy ratings, however, were considerably lower. Only
18.3 percent called the number of staff excellent and 43 percent
called it good, with the remaining 27.7 percent rating it fair or
poor.
Click here to view the
report, along with AHCA and My InnerView news releases.
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Home Care and Others in Toronto Join Forces to Advocate for Wages,
Benefits
Home care providers and other human services providers in Toronto
have formed a coalition - but this time, they're speaking up for
their own rights. The civil servants recently held a brainstorming
session to try to figure out how to press the government that funds
their work for better pay and benefits.
According to
"Too Selfless for their Own Good,"
a July 21 feature in the Toronto Star, the city's civil servants are
motivated by "a desire to serve those in need, build a stronger
society and live according to their values. That makes them easy
targets for government cost-cutters. They care too much about their
clients to quit. And they're too busy delivering vital services to
speak out or fight back."
The group issued a
statistical report
on working conditions in the community service sector. And in their
first meeting, members agreed that the community service sector has
to get better at telling its own story and managers of non-profit
agencies have to stop being so timid about offending political
leaders. They also resolved to be "a little less nice, a little less
naive and lot better at standing up for themselves," the article says.
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Adding Illness to Injury
Once again the Bureau of Labor Statistics (BLS) has compiled
statistics on the number of job-related illnesses and injuries
experienced by U.S. workers, and once again direct-care workers are
at the top of the list. Over a 10-year period from 1995 to 2004, only
truck drivers, laborers, and material handlers reported more injuries
than the three direct-care job categories the BLS tracks - home
health aides; psychiatric aides; and nursing aides, orderlies, and
attendants.
According to
Occupational Injuries, Illnesses, and Fatalities among Nursing, Psychiatric, and Home Health Aides, 1995-2004,
nearly 800,000 of these workers were injured or became sick on the
job during that decade, accounting for about 5 percent of all the
nonfatal work-related injuries and illnesses recorded.
Musculoskeletal disorders (disorders of the muscles, nerves, tendons,
joints, cartilage, or spinal discs) were the most common type of
nonfatal injury or illness reported, and the most common cause of
injury was overexertion.
While the number of injuries and illnesses remains high relative
to most other occupational groups, there was a steady and significant
decline in the number of cases over the 10-year period studied.
According to the report, this was due largely to fewer reported cases
of overexertion.
Other common causes of on-the-job injuries were falls and
assaults, usually by a patient or resident. Nursing, psychiatric, and
home health aides represented nearly 30 percent of the total number
of workplace assaults during the 10-year period - the highest
proportion experienced by any broad occupational group.
Two-thirds of the reported cases of non-fatal injuries and
illnesses were sprains, strains, and tears. The second most common
kind complaint was soreness and pain. This accounted for 11 percent
of injuries, of which nearly half were attributable to back pain.
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September 11, 2006 - September 12, 2006
Iowa CareGivers Association Annual Conference, West Des Moines, IA
September 11, 2006 - September 13, 2006
14th Annual Alzheimer's Association Dementia Care Conference,
Atlanta, GA
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