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July 20, 2007
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In This Issue:
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Guaranteed Hours Boost Retention in Home Care
"Total earnings for direct-care workers depend on total hours worked per week - in addition to the hourly rate," says Workforce Strategies 4: The Guaranteed Hours Program. "When a worker's case is closed - such as when the client is hospitalized - the worker not only loses the case, but also the hours and the associated wages."
That fluctuation in hours, the publication points out, often forces workers to seek other employment, so one way to increase retention is to ensure that your longer-term, more stable workers are paid for at least a minimum number of hours each week. The Guaranteed Hours Program describes one such program at Cooperative Home Care Associates (CHCA) in the South Bronx, New York.
Consumers Suffer Effects of Poor Wages and Training and Lack of Respect for Direct-Care Workers
Many consumers using paid personal assistance services (PAS) believe that experiences with poor care are the result of low wages, lack of training, or disrespect of the workforce, although most are satisfied with their PAS providers, according to a recent study.
"Paid Personal Assistance Services: An Exploratory Study of Working-Age Consumers' Perspectives" examines the experiences of people who use paid PAS. Through telephone interviews, 24 working-age users of paid PAS indicated satisfaction with their current PAS and "talked about how PAS 'saved' them, allowing for new opportunities for community and social involvement."
But most respondents wanted more. Interviewees expressed dissatisfaction at the scope of PAS programs, wishing more services and paid hours of PAS assistance were available.
Click here for the rest of the story.
Peer Mentoring as a Culture Change Tool
An article in the June 2007 issue of Contemporary Long-Term Care highlights accomplishments and recommendations from a peer mentoring program at the Center for Nursing and Rehabilitation, a large nursing home in Brooklyn, NY.
The facility began a culture change journey in 1997, but the managers soon discovered, as the article puts it, that "they were overlooking a valuable resource" -- their direct-care workforce. To improve retention, the facility used a grant from the New York State Department of Health to provide ten CNA mentors with training in leadership skills, person-centered practices, and dementia care.
Click here for the rest of the story. And click here for more on CNR's peer mentoring program.
CNR's peer mentors are pictured below.
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Recent additions
Click here for more news from the Clearinghouse.
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2007 Progress Report from Maine
LD 1687, An Act to Increase Health Care Coverage for Front-line Workers in Long-term Care, was still alive when the Maine legislature wrapped up its 2007 session. The bill, which would create a pilot program to increase health care access for direct-care workers, has been carried over to the session that convenes in January 2008. Meanwhile, a legislative committee of House and Senate members will study Maine's Dirigo Health insurance program over the summer in hopes of arriving at an agreement and a means to provide additional funding to continue the program's growth.
The Maine Direct Care Worker Coalition worked hard to promote both bills and to ensure that they meet the needs of direct-care workers. The coalition is regrouping this summer to consider various study mandates regarding this workforce from the session and to develop strategies for moving its proposals forward in January.
Click here for the rest of the story.
Tracking Health Care as a Campaign Issue
The Kaiser Family Foundation is doing its part to keep health care high on the list of issues discussed in the 2008 presidential campaigns with a new website, Health08.org. The ad-free site includes:
Analysis of health policy issues;
Summaries of health reform proposals;
Facts about the health system;
Public opinion survey results
A calendar of events taking place nationwide;
News and video coverage from the campaign trail; and
Interviews with candidates and other key players in the health reform debate.
Click here for the rest of the story.
Reporter Describes the "Astonishingly" Poor Pay and Benefits of Direct-Care Work
"The chasm between the importance of the job and the remuneration is astonishing," writes journalist Lauren Kessler, author of a book about caring for people with dementia, in an online commentary for Newsweek. The June 10 web article, "Bridging the Gap," summarizes four months Kessler spent as a nursing assistant at a residential Alzheimer's facility in Oregon, gathering material for a book titled Dancing with Rose.
Click here for the rest of the story.
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More Information
Click here to read more from and about the HCHCW campaign.
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Alzheimer's Association Notes Challenges in Consumer-Direct Care
Despite the many benefits of consumer-directed care, this rapidly spreading model of care presents "special challenges" for people with dementia and their families, according to Consumer-Directed, Home and Community Services for Adults with Dementia, a new public policy issue brief from the Alzheimer's Association. Author Jane Tilly, DPH, examines the effectiveness of consumer-directed programs for this population and their caregivers, looks at their need for support, and describes key program provisions in 11 state programs, drawing on input from program officials. Tilly also provides policy recommendations for states.
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According to the new movie Sicko, 50 million Americans lack health insurance. What percentage of direct-care workers don't have health care coverage?
1 in five--0%
2 in five*--22%
3 in five--78%
*Correct answer
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Dear Friend,
Once again, we have a number of new jobs open at the Paraprofessional Healthcare Institute, the parent organization for the clearinghouse that publishes this newsletter, and at some of our sister organizations. For job descriptions and details on how to apply, scroll to the bottom of the home page of the PHI website.
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Community Colleges Awarded for Innovative Training Programs
Twelve community colleges were awarded grants of up to $25,000 this month to establish new training programs or enhance existing programs for direct-care workers who provide care in the home. The awards, which were announced on July 12 by The Caregiving Project for Older Americans (http://www.ilcusa.org/prj/caregiving.htm) and the MetLife Foundation, (www.metlife.org), are an attempt to raise awareness of the need for better training for both professional and family caregivers by recognizing community colleges with innovative programs.
The winning community colleges include schools in Arkansas, Kansas, Maryland, Oregon, Pennsylvania, Texas, Vermont, Virginia, Washington and Wisconsin. Click here for details.
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Michigan Providers Show Way to Improved Care Practices, Outcomes
The cover story for the summer 2007 issue of Quality Counts, the newsletter for Michigan's quality improvement organization, calls on long-term care providers to follow the example of innovative peers and reject outdated assumptions, boosting job and care quality statewide. "Michigan homes have radically improved care practices and outcomes in the recent past and we can do it again, now," writes PHI Michigan State Director Hollis Turnham in "Radical Change: Past and Future."
Turnham cites the examples set by two long-term care organizations and a consortium of health care providers, all of which reduced turnover and increased retention among nursing assistants by changing facility practices and policies. Successful strategies include improving wages and benefits; creating teams supported by coaches that focus on customer satisfaction, empowering staff, and enhancing staff decision-making skills; and providing staff with "personal coaching, consistent support, and follow through that helps employees sustain their efforts to address personal challenges and their hopes for the future."
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Building on the Link Between Staff Satisfaction and Care Quality
Two recent articles in Provider magazine explore the link between staff satisfaction and empowerment and care quality in long-term care. The articles share lessons learned through surveys conducted by My InnerView, a web-based system of measuring and improving performance.
"The Critical Link Between Workforce Organization and Excellence" looks at Georgia nursing homes, finding that facilities with high employee satisfaction rates also scored significantly better on clinical outcomes, workforce performance, and occupancy rates. In analyzing the data, the surveyors note: "What's so striking about these results is just how important workforce is to quality." They recommend several "strategies for strengthening your workforce," including taking care of and valuing your employees, monitoring their performance, involving them in decisions, and understanding their needs.
"Making the Quality Connection" analyzes what residents, their family members, and staff really care about and what constitutes "quality" from their point of view. Here too, the researchers found that a more stable and satisfied workforce made for happier residents. While the focus in quality improvement efforts is often on clinical measures reported in the MDS (minimum data set), the articles notes, "these measures are not as predictive of satisfaction as other measures such as workforce performance (employee turnover, retention, and absenteeism)." The authors also explore how to more effectively use information from satisfaction surveys to improve a facility's performance.
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Technical Assistance Grants Available to States
The application for the 2008 round of in-depth technical assistance from the National Direct Service Workforce (DSW) Resource Center will be available as of August 1. Applications will be due on August 31.
The technical assistance helps states develop or implement initiatives to strengthen the home- and community-based workforce that supports people with disabilities. State Medicaid agencies and their partners are encouraged to apply. The resource center is a project of the federal Centers for Medicare & Medicaid Services. Technical assistance will be provided by a team led by The Lewin Group with support and expertise provided by Paraprofessional Healthcare Institute, University of Minnesota's Research and Training Center on Community Living, the Institute for the Future of Aging Services, and the Westchester Consulting Group. Other experts may also be brought in as needed.
Click here to learn more about the application process, download a form when available, or read about past grantees.
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Learning by Listening to How CNAs Talk to Residents
An article in the current issue of Health Communication (Vol. 22, No. 1) looks at the importance of "affective communication" between long-term care residents and the nursing assistants who assist them.
"Older adults in long-term care facilities have few opportunities for emotionally meaningful social interactions with non-institutional social ties; yet having such relationships is a basic human need that affects well-being," note the authors of "In a Manner of Speaking: Communication Between Nurse Aides and Older Adults in Long-Term Care Settings." "Affective communication can enhance relationships between residents and nurse aides, who provide most of their care."
The researchers recorded CNA-initiated communication with residents at mealtimes to analyze the relationship between staff comments and resident responses. Four types of "affective communication" were identified: personal conversation, addressing the resident, checking in, and emotional support/praise. The authors recommend incorporating their findings into training programs to help nursing assistants learn how to relate effectively to residents.
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Reopening that Case of Coke...
The U.S. Supreme Court's resounding slap in the face to home care givers, delivered in its June 11 ruling on Long Island Care at Home v. Coke, may not have been widely reported in the mainstream media, but it appears to have been heard by politicians. Some are looking to undo the damage done by the decision, which found home care workers to be ineligible for overtime pay or minimum wage protections under the Fair Labor Standards Act.
In an article published by a Minnesota union, Senator Tom Harkin (D-IA) says he is working on a bill to overturn the decision. "The time is right and we've waited a very long time to put this sad chapter behind us," he adds.
Meanwhile, presidential candidate John Edwards's website promises that, if elected, the former senator "will amend the Fair Labor Standards Act to include home health care workers, effectively reversing the Long Island Care at Home v. Coke decision that excluded them from these protections. He will also extend collective bargaining rights to home care workers and strengthen Medicaid's support for long-term and home-based care."
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... And Moving that Ball (v. Biedess)
A July 17 ruling by the Ninth Circuit Court of Appeals affirmed that Medicaid beneficiaries are entitled to sue for their right to receive long-term care in home and community-based settings (HCBS), sending the case back to the district court. However, the court ruled that consumers can't challenge the wages being paid to attendant care workers.
In the class action lawsuit, titled Ball v. Biedess, low-income home care recipients in Arizona, represented by attorneys from the AARP Foundation Litigation and the Arizona Center for Disability Law, charged that the state's Medicaid HCBS managed-care program failed to provide the attendant care workers they were promised, leaving them stranded without critical health care services. U.S. District Court Judge Earl Carroll found in favor of the plaintiffs, ruling that the state's failures violated the law. He also found that the shortage of workers was due in part to low wages, and charged the state to pay enough to make those jobs competitive and ensure an adequate workforce to meet the needs of care recipients.
The state's appeal was based on a claim that the Medicaid recipients had no right to appeal to the court. In rejecting that claim, the appeals court is also asking the district court to determine whether Arizona violated the Americans with Disability Act and the Rehabilitation Act in failing to provide needed care.
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August 1-3, 2007
Pioneer Network 2007 Conference, Philadelphia, PA
August 10, 2007
Is a Caring Society Possible? Mobilizing for Social Change, New York, NY
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