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March 13, 2006 |
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High Turnover, Low Quality
An article in the February issue of
The Gerontologist reports that high turnover among certified
nursing assistants (CNAs), licensed practical nurses, and registered
nurses is associated with lower care quality, with the strongest link
being found to high turnover among CNAs.
According to "Organizational characteristics associated with
staff turnover in nursing homes," poor care quality may be a cause as
well as an effect of high turnover rates because "the
job-satisfaction literature would suggest that nursing staff value
caring for residents in a high-quality fashion." Authors Nicholas
Castle and John Engberg recommend caution in interpreting their
findings. However, they suggest, the link between low quality and
high CNA turnover "may be an indication that the seemingly
intransigent low-quality levels in nursing homes in recent years may
be partially responsible for continued high staff turnover."
Click here
to read the article (free of charge only to subscribers).
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Help Wanted
The majority of frail elders in the United States (61.3 percent)
receive some form of assistance from a family, friend, or paid
worker, with most of those receiving care from unpaid family members,
according to a report published this month by the Urban Institute.
A profile of frail older Americans and their caregivers
uses the 2002 Health and Retirement Study to profile the frail
elderly and their paid and family caregivers.
Authors Richard Johnson and Joshua Wiener discuss the fact that
the number of people needing care is expected to rise while the
availability of family caregivers may decline due to rising divorce
rates, increasing childlessness, declining family sizes and rising
employment rates among married women. They also find that "paid home
care is rare," accounting for only 22 percent of the hours of care
provided to people with severe disabilities. "[A]dditional support
for home- and community-based care is likely to be necessary to keep
most frail older Americans out of nursing homes," they note.
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WIA Invests in Health Care Workers
A report on the Workforce Investment Act of 1998 looks at how WIA
resources have been used to support direct-care workers and others in
the health care workforce.
Effects of the Workforce Investment Act of 1998 on health workforce development in the states,
which was published by the Health Resources and Services
Administration (HRSA) of the U.S. Department of Health and Human
Services, also explains WIA's origin, goals, and structure and
outlines the role played by local workforce investment boards in
implementing WIA programs.
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CARF Solicits Input on Dementia Care Standards |
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CARF, a nonprofit organization that accredits long-term care and
other human services organizations, is soliciting input on a new set
of standards for dementia care programs. These standards can be
applied to all long-term care and service settings, including adult
day services, assisted living, nursing homes, and CCRCs. The field
review, which began on March 1 and will end on April 5, can be
completed by one user in multiple visits. CARF also published new
standards for person-directed long-term care in nursing homes this
January.
Click here
to comment on the dementia care standards.
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Ensuring Person-Centered Practices in Home Care |
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An issue paper published last month by the AARP Public Policy
Institute illustrates several states' attempts to craft a more
person-centered approach to quality assurance in publicly funded home
care services and supports.
Home Care Quality: Emerging State Strategies to Deliver Person-Centered Services
reviews all state quality systems and analyzed three states
(Wisconsin, Washington, and South Carolina) in more detail.
Click here
to download the paper or a two-page issue brief outlining its
findings.
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Trying to Ease the Tricky Transition from Welfare to Work |
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Transitioning from welfare to work is not easy even when support
services are available, according to a recent report on a South
Carolina program aimed at helping former welfare recipients obtain
jobs, work more steadily, and move up in the labor market. The
program, called Moving Up, was part of the Employment Retention and
Advancement (ERA) project, which is funded by the U.S. Department of
Health and Human Services and the U.S. Department of Labor. Between
September 2001 and April 2005, it offered one-on-one case management
in six rural counties, providing or connecting participants with
services including job search assistance, short-term vocational
training, and support services. It also provided modest financial
incentives. The study found that the program had little effect on
employment rates, earnings, employment retention, or advancement,
although it did have positive effects on employment for participants.
The authors note that their study is not the final word on the
program but conclude that it illustrates "the persistent challenge of
encouraging participation in post-employment services and making a
difference in labor market outcomes for welfare leavers."
Click here
for details.
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CMS Looks at Eight States' Rebalancing Efforts |
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Researchers at a recent open-door forum held by the Centers for
Medicare & Medicaid Services (CMS) presented initial findings from a
three-year research project looking at how various states are
"rebalancing" their Medicaid programs to increase long-term care
spending on home- and community-based services. The report focused on
eight states -- Arkansas, Florida, Minnesota, New Mexico,
Pennsylvania, Texas, Vermont, and Washington -- outlining what each
is doing and the challenges it faces. New Mexico, it notes, is
including a living wage for home- and community-based direct-care
workers in its design.
Click here
for a CMS PowerPoint presentation of the findings.
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Does offering health care coverage help stabilize the direct-care workforce?
Yes:
89%
No:
11%
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Dear Friend
Longtime subscribers will remember that we sent a survey to this
list some years ago asking what we could do better in
Quality Jobs/Quality Care and on the National Clearinghouse
on the Direct Care Workforce to serve your information needs. You
gave us a tremendous amount of useful feedback, so we're planning to
send out another survey soon. Please keep an eye out - it should show
up in your e-mail inbox later this week - and try to find the time to
fill it out. Your input is invaluable to us.
Meanwhile, if you are a direct-care or direct support worker who
wants to help improve direct-care jobs in Maine, or if you know
someone who fits that description, Maine PASA wants to hear from you.
The association is looking for two direct-care workers to work
part-time as leadership development apprentices for ten months.
Leadership apprentices will "develop their leadership skills, speak
on behalf of direct-care and support workers and Maine PASA, and lead
efforts to build recognition and opportunity while promoting
professionalism for the workforce."
Click here
for a job description and information on how to apply.
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Coaching Curriculum Available in Spanish
The Paraprofessional Healthcare Institute's introduction to coaching
supervision is now available in Spanish as well as English. All seven
modules of the 202-page package, including the handouts and appendix,
have been translated.
The two-day course introduces supervisors of direct-care workers
to the skills they need to effectively help workers solve problems
and improve work performance. The curriculum includes learning
objectives, activities, questions for discussion, and all necessary
handouts. It is applicable to both nursing home and home care
settings. The entire package may be downloaded free of charge or
ordered in printed form for $95 including shipping and handling (the
printed version is collated and put it into a three-ring spiral
binder with divider pages.)
Click here
to download or order the modules.
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CMS Tells States to Stop Charging CNAs for Nurse Aide Registry Placement
The Centers for Medicare and Medicaid Services (CMS) is instructing
states to stop charging nursing assistants for placement on their
nurse aide registries, thanks to a report by the Office of Inspector
General (OIG) in the U.S. Department of Health and Human Services.
The Nursing Home Reform Act of 1987 that required every state and
the District of Columbia to establish its own registry for certified
nursing assistants (CNAs) also forbade states to charge workers for
joining or remaining on the list. However, as the OIG reports in
State Fees for Nurse Aide Registration,
nearly half the states (24) require CNAs to pay for placement on
nurse aide registries.
Click here
for the rest of the story.
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Growing a Strong Organizational Culture
Assisted living workers whose organizations promote teamwork,
participation in decision-making, and supportive relationships among
staff return the favor by exhibiting greater commitment to their
organizations, according to a study published in the February issue
of the
Journal of Gerontological Nursing.
For "Organizational Culture and Work-Related Attitudes Among
Staff in Assisted Living," researcher Elzbieta Sikorska-Simmons
administered questionnaires to staff in 61 facilities. "Overall,
organizational culture emerged as a strong predictor of work-related
attitudes," she reports, explaining 36 percent of the variance in job
satisfaction, 50 percent of the variance in satisfaction with
coworkers, and 48 percent of the variance in organizational
commitment.
Sikorksa-Simmons recommends that "interventions aimed at changing
staff attitudes should focus on creating organizational cultures that
promote teamwork, high organizational morale, participation in
decision making, and supportive relationships among staff. In
particular, efforts to improve staff attitudes should address the
underlying cultural assumptions concerning the value and the role of
staff in the provision of care. As stressed by advocates of culture
change in long-term care, only staff members who feel valued and
respected will be able to provide the quality of care that residents
need."
Click here
to read the article (free to subscribers only)
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Unions Push to Enlist Direct-Care Workers
The push to unionize direct-care workers is intensifying, with unions
"targeting nursing homes, hospitals and home care workers," according
to a February 26 feature in
The Detroit News.
The article points out that the Service Employees International
Union (SEIU), the nation's fastest-growing union, "has long
represented health care workers," but adds that "even unions without
well-established links to health care are now looking to medical
workers - from nurses providing care in hospital wards to home care
workers tending to elderly patients - to replenish ranks that have
been shrinking for decades as manufacturing jobs move overseas." For
example, it says, the United Auto Workers union launched a joint
campaign last year with the Michigan Nurses Association to target
health care workers outside of nursing, "from pharmacists to clerical
workers at hospitals."
The SEIU won the right to represent 40,000 Michigan home care
workers last summer, more than doubling its membership in that state
to 78,000.
Click here
to read the article.
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Maine Senator Advocates for Improving Direct-Care Jobs
In an editorial in the February 24 issue of the
Portland Press Herald, Maine Senator Beth Edmond describes
the growing need for direct-care workers in her state and the reasons
behind the shortage. She also describes two bills she has sponsored
to address the problem.
LD 1934, An Act to Improve Retention, Quality and Benefits for
Direct Care Health Workers, calls for a study to determine how much
it would cost the state to make its direct-care jobs competitive
enough to recruit and retain a qualified work force. It would also
explore setting up a comprehensive direct-care registry.
LD 1991, "An Act to Ensure the Availability of Consumer-directed
Personal Assistance Services," calls for a wage increase for 1,000
workers who provide assistance to adults with disabilities and who
have not had a wage increase in eight years.
Click here
to read the editorial.
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Retention is Key, says Iowa Editorial
A March 5 editorial in the Des Moines Register calls for
addressing the growing shortage of direct-care workers in long-term
care. The editors, who talked to Di Findley of the Iowa CareGivers
Association for background, note that "the greatest need is to
improve retention of direct-care workers already in the field."
Better pay, health insurance, better training and mentoring,
avenues for advancement, and greater respect are cited as effective
means of improving retention.
Click here
to read the editorial
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April 29, 2006
American College of Health Care Administrators 40th Annual Conference
and Exposition, Neville Grange Resort, New York
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April 3, 2006
Future of Aging Services Conference, Washington, D.C.
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