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May 17, 2007
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In This Issue:
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Improving End-of-Life Care in Nursing Homes
"Because 66 percent of the individuals who enter nursing homes can expect to die there, recognizing the problems that influence end-of-life in the nursing home can substantially reduce suffering for patients and their families," says Alison Carlson in the Journal of Gerontological Nursing. Carlson did a literature review of empirical research studies to look at shortcomings of end-of-life care from the perspective of those most affected: residents, family, and staff.
According to studies cited in "Death in the Nursing Home: Resident, Family, and Staff Perspectives," conflicts between families and physicians and CNAs and nurses, as well as lack of time and resources, limit effective end-of-life care. Studies also indicated that lack of inclusion in resident care planning, poor communication among staff, and insufficient time to discuss resident care may all contribute to lower quality of care for the dying—and to stress and isolation among certified nursing assistants (CNAs).
The article calls for further research directed at understanding cultural diversity in end-of-life care, empowering nurses to improve care, and modifying government reimbursement policies to include payment for palliative care.
Supply and Demand Laws Don't Apply Here
Paid care services in health care, childcare, and education do not follow the "textbook fantasies" of supply and demand, making it more difficult to improve care quality, according to an article by economist Nancy Folbre.
Textbook economics teaches that supply and demand naturally adjust to each other, Folbre explains, but care is "a necessity rather than a luxury," so demand for care doesn't increase and decrease like demand for commodity goods. Instead, rising prices often widen the gap in the quality of care available to people with low and high incomes, or "shift the burden to the public sector" -- a shift that inevitably places pressure on institutions to cut costs and cut corners on quality.
"Demanding Quality: Worker/Consumer Coalitions and 'High Road' Strategies in the Care Sector" recommends the following political strategies to improve care quality:
Build links among care sector workers
Emphasize the common interests of care providers and recipients
Challenge claims that "care should not pay"
Promote unionization
Reconceptualize the role of the public sector
Publicize and encourage "best practices" management.
The article appears in the March 2007 issue of Politics and Society.
Unionized Homes Do Better on Surveys
A study of unionized nursing facilities in California found that they were cited for fewer serious violations than non-union facilities on their annual surveys.
Unions for nurses and nursing assistants typically focus on issues that affect quality, such as inadequate staffing and occupational health and safety, and "union attention is sometimes focused directly on processes of care...including citations for poor-quality care and/or on quality improvement processes," point out authors James Swan and Charlene Harrington. The authors also found that unionized facilities average three complaints per 100 beds more than non-unionized facilities, but the number of violations that could cause residents harm was lower in unionized facilities.
"California Nursing Facility Quality and Union Environments" also found that an overall "union environment" in any given county is associated with less violations. The study was published in the April 2007 issue of the Journal of Aging and Health.
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Recent additions
Click here for more news from the Clearinghouse.
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HCHCW Pennsylvania Debriefs Legislators
The Pennsylvania HCHCW initiative has been spreading the word through some pretty big megaphones lately.
On May 4, the campaign's parent organization, the Paraprofessional Healthcare Institute (PHI), held a legislative briefing for legislators in Western Pennsylvania's Allegheny County. The briefing focused on how a new legislative plan to reform health care would benefit direct-care workers. The proposal would subsidize workers who earn less than 300 percent of the federal poverty level. Since the average wage for a direct-care worker in Pennsylvania is $9 an hour, most would qualify for subsidies. That same day, the Pittsburgh Post-Gazette ran an editorial by Tracy Lawless, head of the Pennsylvania HCHCW initiative, about the need for affordable health insurance for direct-care workers. Lawless also did a radio interview on Metro Networks News after the hearing.
Click here for the rest of the story.
Below, Representative Jake Wheatley and former Senator Allen Kukovich listen attentively at the May 4 Pennsylvania briefing.
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Getting the Word Out in Maine
The leaders of the Health Care for Health Care Workers team in Maine described the challenge of finding and keeping direct-care workers and the need for affordable insurance on State of the State, a television show hosted by Lisa Pohlmann of the Maine Center for Economic Policy (MECEP).
Also appearing on "Proposals for a More Stable Direct Care Workforce" on April 24 was HCHCW's Roy Gedat, the outgoing executive director of Maine PASA, along with Maine Senate President Beth Edmonds and Susan Rovillard, the executive director of a home care agency. They discussed several legislative initiatives aimed at improving recruitment and retention, including LD 1687, a bill to provide access to health benefits for direct-care workers. Edmonds is the lead sponsor of the legislation.
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Addressing Virginia's Workforce Committee
Carol Regan, director of the HCHCW initiative, was invited to talk to a health care workforce committee in Virginia about the needs of direct-care workers—and the importance of affordable health insurance. Regan spoke to the Workforce Committee of the Virginia Health Reform Commission on April 18.
The committee is one of four appointed this year by the governor to explore ways of improving access to quality health care. Its final recommendations to the governor are expected to be issued on June 12.
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More Information
Click here to read more from and about the HCHCW campaign.
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Where I live, a "living wage" is a minimum of:
Less than $10 an hour—40%
$10-$12 an hour—13%
$12-$14 an hour—20%
More than $14 an hour—27%
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Dear Friend,
Due to a technical glitch, the issue of the Quality Jobs/Quality Care sent out this morning had some problems generating links within the newsletter. The problem has been fixed in this version. We apologize for any inconveniences this may have caused.
Next month marks the 30th year for Nursing Assistant Week. The theme this year is Respect, and each day of the week, June 14-21, will focus on a different aspect of that theme. For more information on the event and tools to help you observe it, visit the National Network of Career Nursing Assistants website.
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Calling All Pennsylvania Direct-Care Workers
Direct-care workers in Pennsylvania have a rare opportunity to talk to a powerful elected representative who wants to learn more about their concerns. In a meeting set up by a direct-care worker, Senator Bob Casey will be coming to a community hospital in Lewisburg on June 18 to talk to any direct-care worker who wants to and can meet with him.
The genesis of the event was a February workshop organized by CARIE to explore lessons learned from Pennsylvania's Better Jobs Better Care (BJBC) project and discuss ways of continuing to support and stabilize the state's direct-care workforce. Hopsice aide Brenda Nachtway (above), who is on the BJBC worker advisory board, spoke on a panel about what she would like to see change for direct-care workers, and Casey's deputy chief secretary heard her and was impressed by her eloquence and passion. "I cried through the whole thing," says Nachtway. "I said, 'I'm sorry, but I just care so much about this, and I feel so passionate about the work we do.' The moderator kept saying, "It's ok, take your time,' and I said, "I can't take my time because you only gave me five minutes."
Click here for the rest of the story.
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Creating Respectful Workplaces
"Creating a workplace environment in which workers can feel respected, listened to and supported is a critical challenge for leaders in long-term care," according to Respectful Relationships: The Heart of Better Jobs Better Care, the latest issue brief from the Better Jobs Better Care project.
The 16-page brief looks at behaviors that cause workers to feel disrespected and offers examples of organizations that have created more positive and understanding workplace cultures. It also lists six practical suggestions on how providers can "make respectful relationships the heart of their organizations' commitment to quality care."
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Supreme Court Hearing Brings Home Care Pay into Focus
The arguing of Coke v. Long Island Care at Home last month inspired a spate of mainstream media stories about low pay for home care aides, all of which are still housed on the internet for those who missed them the first time around.
On April 15, NPR's All Things Considered aired an elegant four-and-a-half-minute analysis that concluded: "the kind of planning needed to figure out how to pay for the country's growing home care needs just isn't being done ... and fighting over paying home health aides overtime isn't going to help."
On April 17, New York Times labor reporter Steve Greenhouse ran a story about the case and the first day of Supreme Court hearings, noting that several of the justices "showed little sympathy" for the argument that home health aides should be made eligible for overtime pay under the Fair Labor Standards Act. And on April 18, Greenhouse and Steven Dawson of the Paraprofessional Healthcare Institute discussed the case and its implications and responded to questions and comments from callers on WNYC radio's Brian Lehrer Show.
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Presidential Candidate Takes a Walk in the Shoes of a CNA
Presidential candidate John Edwards responded to a plea to help call attention to the contributions and needs of direct-care workers by accompanying nursing assistant Elaine Ellis on her rounds at the Sarah Neuman Nursing Center in Westchester, New York. The former senator's tour was part of a Walk a Day in My Shoes campaign organized by the Service Employees International Union (SEIU).
The senator's visit spurred some media interest, though a segment on Good Morning America adopted a cynical tone, spinning the story as just a way to curry favor with unions and a new form of "extreme campaigning." A written story on the ABC website included virtually all the same facts and quotes as the newscast but deleted that angle. "It's important for the president of the United States to understand how difficult these jobs are, and how important they are," Edwards told ABC.
The candidate began his day at Ellis' home, rode to work with her, and helped her assist residents, shaving one, helping others to eat, and more. "He did just fine," said Ellis. "I didn't expect him to do so fine."
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ANCOR Names Direct Support Professional of the Year
The American Network of Community Options and Resources (ANCOR) named Larry Skinner National Direct Support Professional of the Year and named 36 other honorees for its inaugural Direct Support Professionals (DSP) of the Year contest last month. Skinner "epitomizes the very best in the commitment, sensitivity and passion that direct support professionals bring to the job," said ANCOR President Peter Kowalski in a news release.
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Measuring CNA Job Satisfaction
Nursing assistants in nursing homes get the most satisfaction from working with residents and the least from their pay, according to a recent job satisfaction survey. The survey was returned by just over 1,500 nursing assistants at 72 facilities, a response rate of 55 percent. A report on its findings was published in the May issue of the Journal of Gerontological Nursing.
"In general, nurse aides enjoy working with residents and their coworkers but are less satisfied with pay," according to "Assessing Job Satisfaction of Nurse Aides in Nursing Homes: The Nursing Home Nurse Aide Job Satisfaction Questionnaire."
Click here for the rest of the story.
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Improving Retention in Home Care
Home care agency managers can do a number of concrete things to improve their retention rates, according to an article in Home Health Care Management & Practice.
Author Etelka Froymovich says four key areas influence caregivers' job satisfaction ratings, and therefore improve retention:
The caregiver's relationship with his or her supervisor;
The caregiver's relationship with his or her environment;
Salary, benefits and career progress; and
The caregiver's relationship with his or her professional colleagues.
"How Managers Can Retain Qualified In-Home Caregivers in a Competitive Job Market" lists things managers can to do improve each of these, citing examples of employers that have improved retention.
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Making the Case in Maine
Direct-care worker advocates in Maine have been busy in recent years, as evidenced by a run of recent publications and projects.
An editorial by Joyce Gagnon of the Maine Personal Assistant Service Association (Maine PASA) cites facts from Direct Care Workforce: Wages, Health Coverage, and a Worker Registry, a recent report from the Maine Department of Health and Human Services (DHHS). Gagnon also urges support for several pending bills, which would increase wages or benefits for direct-care workers in the state. Her editorial was published in the April 27 Bangor Daily News.
Meanwhile, the April 25 issue of Choices, a publication of the Maine Center for Economic Policy, is devoted to an analysis of the DHHS report, summarizing key findings and current related legislative initiatives to improve recruitment and retention of the direct care workforce.
In other Maine news, a new online registry service from Maine PASA, Maine PASA Connections, connects people who need personal assistance in their homes with caregivers looking for employment, and an article in the May 6 Kennebec Journal describes challenges facing direct-care workers, with quotes and facts from the Kennebec Valley Organization and the Maine Direct Care Worker Coalition.
See New from HCHCW at left for more news from Maine.
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Staffing is a Moral Issue, Says NCCNHR Head
"This is a moral issue," said Alice Hedt, executive director of the National Citizens' Coalition for Nursing Home Reform, during a C-SPAN interview about nursing home staffing.
Hedt, who had testified before Congress the day before, said she had three messages to deliver, one of which was that "we need increased staffing levels in nursing homes.
"There's only so much that one certified nursing assistant can do, no matter how hard they work," she added. "And if there are not enough certified nursing assistants, residents can't get what they need."
Hedt said the real challenge was not finding good workers but keeping them, "because they have to care for so many residents that they get frustrated and leave. Most certified nursing assistants are very dedicated; they're committed to providing good care, but if they have too many residents to take care of, that's impossible," she said.
Several people called in to report unreasonably low staffing ratios at facilities where they worked or visited loved ones. "The staffing is the biggest problem," said a CNA from Alabama.
The interview aired on May 3.
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PAS Conference Available Online
A webcast of the Center for Personal Assistance Service's State of the Science Conference is now available for those who were unable to attend.
The conference was held on April 27 in Washington, DC. After six months, the webcast will be moved to the Center for PAS website.
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June 1, 2007
Maine PASA Annual Conference, Lewiston, ME
June 14-21, 2007
National Nursing Assistants' Week
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