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April 27, 2006
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In This Issue:
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Study Confirms Link between Training Quality and Retention
A report on a study of nursing homes in Ohio summarizes research on
training for state-tested nursing assistants (STNAs). Researchers
Farida Ejaz and Linda Noelker surveyed direct-care workers and their
supervisors in nursing homes, assisted living facilities, and home
care agencies.
STNAs who were satisfied with their training were more likely to
be satisfied with their work. That finding applied to both initial
and ongoing training, yet nearly half (45 percent) of the STNAs in
nursing homes said their initial training had not prepared them well
for their current position, and more than half (59 percent) said they
had been unable to attend continuing education classes due to the
lack of workers to cover their shifts.
Tailored and Ongoing Training Improve Job Retention recommends
more initial training, including more of a focus on how to respond to
real-life challenges; longer and more in-depth orientation; and more
continuing education.
Click here
to read the executive summary of the report, which was funded by
Better Jobs Better Care.
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Tailored Training Helps Improve Job Performance
A Better Jobs Better Care study of a workforce development program
for nursing homes finds that tailored training programs can help
develop teamwork and improve job performance. In addition, the
researchers found, training direct-care workers' supervisors in a
coaching style of supervision helped solidify relationships between
nurses and nursing assistants and facilitate their working as a team.
Researchers Thomas Konrad and Jennifer Craft Morgan studied WIN A
STEP UP, a program in which workers are given financial rewards for
attending special classes and agreeing to remain at the facility for
at least three months afterward. They also evaluated the results of
coaching supervision classes for supervisors.
STEP UP NOW for Better Jobs Better Care: The Evaluation of a
Workforce Intervention for Direct Care Workers - University of North
Carolina reports improved job satisfaction, job performance, and
morale among nursing assistants who participated in the program. It
also reports improved teamwork among nurses and nursing assistants.
Click here
to read the executive summary.
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On-Site Retention Specialists Improve Job Satisfaction, Retention
Rates
Another Better Jobs Better Care report,
The Retention Specialist Project, found that providing a
retention specialist, who received training and resources to
implement strategies such as peer mentoring, leadership training, and
work/family issue resolution, increased job satisfaction and reduced
turnover.
Turnover declined from 21 percent to 11 percent over the course
of a year in the 32 nursing homes that participated in the training.
Researchers Karl Pillemer and Rhoda Meador found that dedicating
at least 20 percent of a current staff member's time to retention,
providing them with training and resources, and making the program
part of an ongoing effort rather than a one-time fix can improve job
satisfaction and increase retention.
Click here
to read the executive summary.
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AARP Reports Explain Key Aspects of Long-term Care
Two new reports from Enid Kassner of the AARP Public Policy Institute
explain key aspects of long-term care service delivery and financing.
Medicaid and Long-Term Services and Supports for Older People
describes Medicaid long-term services and supports, eligibility
requirements, program spending, number of beneficiaries, and public
policy issues and concerns.
Click here
to access the full report or a two-page fact sheet summarizing its
main points. Home and Community-Based Long-Term Services and Supports
for Older People describes how home and community-based long-term
care services help people with disabilities remain in their homes and
provides data on the sources of payment for these services.
Click here
for the report or a fact sheet summarizing its main points.
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Uninsurance Rates Rise
The percentage of moderate-income U.S. adults who lacked health
insurance during some part of the year increased by nearly 50 percent
between 2001 and 2005. According to a new study from the Commonwealth
Fund, 41 percent of adults with annual incomes between $20,000 and
$40,000 did not have health insurance for at least part of 2005,
compared with 28 percent four years earlier. More than half (53
percent) of adults with annual incomes less than $20,000 went without
health insurance for at least part of 2005, compared with slightly
less (49 percent) in 2001. The researchers estimated that about 48
million U.S. residents are uninsured, and that two-thirds of those
without health insurance were in families in which at least one
person worked full time. Gail Shearer, health policy director at
Consumers Union, told the Los Angeles Times: "What those numbers do
is cry out for public policymakers to take this challenge very
seriously."
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Medicare Part D Hotline for Healthcare Professionals
The Medicare Rights Center has a new hotline for nonprofit
professionals serving Medicare beneficiaries who are struggling to
comply with the new Part D drug benefit. Medicare specialists at
877-RxHelp-0 (877-794-3570) are trained to help health care
professionals explain the new Medicare drug benefit to clients, help
clients get the medications they need, and provide one-on-one
assistance in appealing private drug plan denials. In addition to
technical support, they can provide consumer-friendly educational
materials designed to help Medicare clients make informed choices and
understand their rights under the new drug benefit. The Medicare
Rights Center is a national consumer service organization identifying
new and persistent issues surrounding the drug benefit. RxHelp is
operated weekdays from 10 to 6 EST.
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Dear Friend
We're still compiling results of our National Clearinghouse on
the Direct Care Workforce and Quality Jobs/Quality Care user survey,
but there's one suggestion we want to act on right away. As more than
one survey respondent pointed out, the state section of the
Clearinghouse needs updating - and the readers of this newsletter
could help us do that, if some are willing to volunteer their time.
If you'd like to help us review and update the information on your
state, please e-mail Research Associate Rob Callaghan at
rcallaghan@paraprofessional.org.
Meanwhile, the Clearinghouse, which publishes this newsletter,
has a new web content editor, Hadas Thier. Hadas has only been on the
job for a couple of weeks, but she's already beefing up the website
(check out the new and improved Events listing). She'll be in charge
of getting this newsletter to you, and soon she'll be helping to
research and write news items, too. If you call or e-mail the
Clearinghouse, you may well wind up talking to her. If you do, please
join us in welcoming her.
Our parent company, the Paraprofessional Healthcare Institute,
remains in turbo-hiring mode. To see descriptions of open positions,
go to
PHI's website and
scroll down to the job listings at the bottom of the page.
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New Peer Mentoring Curriculum Available
A new curriculum from the Paraprofessional Healthcare Institute
includes all the tools necessary to teach peer mentoring in either
home-based or facility-based long-term care.
Peer Mentoring: A workshop series for direct-care workers in home
and residential care is an interactive, learner-focused program that
stresses three skill areas: leadership, communication, and
problem-solving. Eight modules prepare mentors to model caregiving,
communication, and problem-solving skills; help mentees build
confidence in their abilities; and give mentees constructive feedback
as well as information about job responsibilities and the workplace.
The facilitator's guide includes module goals, learning outcomes,
step-by-step activity guides, and handouts. While it can be
downloaded free of charge from the internet, conveniently organized
printed copies in a three-ring binder will be also available by
mid-May.
Click here
for ordering information.
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Study Recommends Better Turnover Measure
While turnover appears to be higher among nursing assistants than any
other caregivers in most nursing homes, wide variations in the way
turnover data is gathered make it impossible to be sure of the
numbers, according to Measuring Staff Turnover in Nursing Homes.
Author Nicholas G. Castle of the University of Pittsburgh
reviewed nursing home literature from 1990 through 2003 to find how
much turnover was reported and how it was measured. The data was
collected from a survey mailed to administrators of 526 nursing homes
in four states in March 2003.
Castle found an adjusted annual turnover rate of 119 percent
among nursing assistants - considerably more than the next-highest 89
percent for licensed practical nurses or 87 percent for registered
nurses, and considerably more than the averages for administrators
and directors of nursing.
However, Castle says, the variations in how turnover is defined
could influence the difference between these reported rates by as
much as 47 percent. He recommends that providers implement more
consistent methods of gathering data, defining turnover as "the total
number of staff (measured in FTEs) who leave employment during a
6-month period divided by the total number (measured in FTEs) who
were employed during the period. This calculation," he adds, "should
include all shifts, part-time staff, and voluntary and involuntary
turnover."
Click here
to read the article.
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Michigan Advisory Commission Charged with Improving Direct-Care Jobs
Michigan Governor Jennifer M. Granholm has created a task force to
help the state upgrade its long-term care system in several ways, one
of which is improving the quality of direct-care jobs.
The Michigan Long-Term Care Supports and Services Advisory
Commission was appointed to implement the recommendations of the
Governor's Medicaid Long-Term Care Task Force, whose
Recommendation Number 8
calls for the state to "Build and sustain a competent, highly valued,
competitively compensated and knowledgeable long-term care work
force."
"The task force recommendations lay out the link between quality
of care and the quality of training, leadership, and compensation
associated with careers in long-term care," says Hollis Turnham, vice
chair of the commission and the Michigan Policy Director for the
Paraprofessional Healthcare Institute. Turnham and two of the other
13 appointees to the advisory commission were chosen to represent
direct-care workers. One represents the general public, three
represent providers of Medicaid-funded long-term care supports and
services, and the other seven represent primary and secondary
consumers of long-term care supports and services.
The commission will assist the Office of Long-Term Care Supports
and Services, which is the sole developer of long-term care policy
within Michigan's Department of Community Health.
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AARP Evaluates CNA Training, Issues Recommendations
Training Programs for Certified Nursing Assistants, an issue paper
from the AARP Public Policy Institute, examines the adequacy of
training for certified nursing assistants by studying programs in 10
states. Esther Hernández-Medina of Brown University and colleagues
interviewed key informants including CNAs and experts in CNA training
and testing.
The authors find a link between high-quality training and
high-quality care and identify a number of weaknesses in current
training programs. They recommend increasing the federal requirement
for initial training to at least 100-120 hours, ensuring that CNAs
are reimbursed for the cost of training, and screening applicants to
training program to identify needs such as remedial English or ESL
classes.
Click here
to read the report.
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Job Satisfaction High among Consumer-Directed Workers
Experiences of Workers Hired under Cash and Counseling: Findings from
Arkansas, Florida, and New Jersey finds that workers in the Cash and
Counseling demonstration, in which direct-care workers are hired and
supervised directly by consumers, are at least as satisfied with
their wages, benefits, and working conditions as agency workers and
suffered comparable rates of on-the-job injuries.
However, a majority of the workers report experiencing greater
emotional strain and receiving less respect, which the researchers
hypothesize is probably due to the fact that most are caring for
friends or family members. Directly hired workers are also less
likely to have received training.
Authors Stacy Dale and colleagues from Mathematica Policy
Research, Inc. looked at all three of the states participating in the
Cash and Counseling demonstration to assess the experiences of
workers. They recommend providing educational material, support
groups, and information for both workers and consumers.
Finding ways to improve worker satisfaction and retention, they
say, is key because the main reason consumers give for dropping out
of the cash and counseling model is difficulty in finding or keeping
a worker.
Click here
to read the executive summary
or here
to read the full report.
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NCAL Reviews State Assisted Living Regulations
The 2006 edition of the National Center for Assisted Living (NCAL)'s
Assisted Living State Regulatory Review sums up 20 categories of the
state laws and regulations that govern assisted living facilities for
each of the 50 states and the District of Columbia. The report covers
requirements for staff criminal background checks and age minimums,
CPR training, staff-to-resident ratios, and both initial training and
special training for Alzheimer's care.
Author Karl Polzer, NCAL's senior director of assisted living
policy, says it's hard to identify national trends, since regulations
vary widely from state to state. However, he says, "There's been a
trend toward higher acuity among assisted living residents, so states
are passing some regulations in response. In particular, a group of
states have regulations for how to treat people with dementia and
Alzheimer's disease, including staffing and educational requirements
for staff."
The 171-page report also provides contact information for each
state's assisted living regulatory agency and offers brief commentary
about regulations and legislation currently under consideration.
Click here
to download the free report.
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Study Examines Supply and Demand in New Hampshire's Elder Care Market
Eldercare in New Hampshire: Labor Market Trends and their
Implications examines the factors that will affect the availability
of direct caregivers in New Hampshire over the next decade.
The 24-page report is generously studded with charts and graphs
parsing current and projected supply and demand in numerous ways. It
also considers other possible sources of direct-care workers,
including occupations that require many of the same skills.
Click here
to download the report.
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Massachusetts Expands Health Care Coverage
Many direct-care workers and their children are sure to be among the
currently uninsured low-income citizens who get affordable health
insurance thanks to the bill passed earlier this month in
Massachusetts. The new law makes more people eligible by, among other
things, making more people eligible for Medicaid coverage and
restoring Medicaid benefits such as adult dental services and vision
care.
Massachusetts has also introduced legislation to establish a
"Direct Care Workers Insurance Assistance Program." That bill, S.
705, would eliminate the employee share of premiums for eligible
direct-care workers who are currently offered employer-based
insurance. It would also cover the full cost of premiums for eligible
workers who are not currently offered employer-based insurance.
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Literature Review Looks at Link between Health Insurance and Retention
A literature review in the April 2006 issue of Mental Retardation
analyzes the evidence that employer-provided health insurance is an
important factor in recruiting and retaining competent and motivated
direct support workers.
"Health Insurance Coverage of Direct Support Workers in the
Developmental Disabilities Field" also outlines approaches to
financing health coverage for direct-support workers and a new
program in New York that will subsidize agencies to enhance existing
coverage.
Click here
to read the article. (Non-subscribers must pay to access it.)
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Editorials Make the Case for Improving Direct-Care Jobs
A spate of recent editorials in newspapers and on websites have made
the case for improving direct-care jobs.
Click here
for the rest of the story.
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Nursing Scholarship Available
Current and former direct-care workers who are studying to become
licensed nurses may want to apply for a scholarship that pays
tuition, fees, other reasonable costs and a monthly stipend. The
application deadline is May 26.
Click here to
learn more about it.
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June 1, 2006
Maine Personal Assistance Services Association annual conference
June 10, 2006
National Association for Direct Care Workers of Color annual
conference, South Bend, Indiana
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