Nursing staff levels and other measures will soon be translated into a five-star rating system for nursing homes by the Centers for Medicare and Medicaid Services, although it is not yet clear how the data will be translated into ratings. CMS is soliciting input into the process during June and July.

In a June 18 press release, CMS called the planned system “ground-breaking,” noting that this is the first time it has ever offered a rating system for any Medicare-funded providers. The agency says the ratings are intended to help residents and their families make “meaningful distinctions between high performing and low performing homes.” The ratings will be posted on the agency’s Nursing Home Compare Web site by the end of this year.

The only nursing staff measure currently on Nursing Home Compare is the number of hours per resident per day. CMS comes up with that estimate by using self-reported data from the homes, calculating the total number of nursing staff per resident day as well as RN, LPN/LVN, and CNA hours per resident day.

But it’s hard to know what to make of those figures with no information about the special needs and acuity levels of each home’s residents – and no way to check on the accuracy of the data to begin with. What’s more, there are no federal minimum nursing staff levels to compare the results to, although some states have their own staffing requirements.

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The Institute of Medicine (IOM) needs more input from direct-care workers on its recent report on the health care workforce, according to a letter (pdf) to the IOM from the Iowa CareGivers Association (ICA).

Retooling for an Aging America, the IOM’s report, did mention the need for more direct-care worker leadership, the ICA letter notes, but only within the workplace. “We strongly believe that there is a need for leadership outside the workplace as well through DCW associations or labor unions so workers can become leaders within their profession and their issues, concerns, and opinions considered directly.”

In addition, the letter urged the IOM to invite DCWs to review and comment on the report. “DCWs bring a unique perspective to these important issues that directly impact them and those they serve, and it is a perspective that has been ignored and devalued for far too long.”

The letter also suggests several other ways of carrying out or bolstering the report’s recommendations. 

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

Read or listen to Colin Bates’ essay

We talk a lot about how direct-care workers help people achieve independence, but isn’t that really a contradiction in terms? I’m wondering because I just listened to Our Vulnerability is Our Strength, an essay read on NPR’s Weekend Edition.

In his June 8 broadcast, Colin Bates (pictured), a resident service assistant and a student at Pennsylvania State University, argued that the key to relationships in long-term care – or any other setting, for that matter – is interdependence. Describing the two men with profound mental retardation who he assists as “my bosses, essentially,” Bates talked about what he does to assist them and why he loves his work. “I believe in helplessness,” he said, “which is to say I believe we need other humans.”

“The cool thing about the guys I work for is that they make their needs explicit,” he said. “Things that take seconds for most of us, like changing socks, can take hours for them, but their vulnerability isn’t a handicap so much as an example. Being with them, encouraging them-‘Yes, the socks are on! The socks are off!’-puts things into perspective.”

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

“If the direct support workforce crisis is not resolved—if direct support workers in the community continue to receive low wages and poor benefits—people with disabilities, family members, and advocates may not have a say in the matter of whether direct support workers become unionized. It is far better to engage in constructive dialogue with forward-looking unions or even a single union than to let events unfold on their own,” says The Direct Support Workforce Crisis: Can Unions Help Resolve This?

Author  Steven J. Taylor says the difference between the pay and benefits earned by direct-care worker in state-operated institutions and the higher amounts earned by their peers in private community services doesn’t necessarily represent an “institutional bias.” Instead, “the discrepancy reflects the fact that state workers are likely to be represented by public employee unions, while private sector workers have not been unionized by and large.”

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Empowering CNAs was found to improve their work performance and job satisfaction, improve resident care, and reduce turnover in a study reported in the Journal of Gerontological Nursing, Vol. 34 No. 3.

In “CNA Empowerment: Effects on Job Performance and Work Attitudes,” Cynthia M. Cready and colleagues from the University of North Texas discuss their study of 298 CNAs and 136 nurses in 10 nursing homes. Five of the homes had CNA-empowered work teams. The other five employed more traditional management approaches.

According to the report, highly empowered CNAs and the nurses who worked with them thought the more empowered CNAs did their jobs better than other CNAs. “Highly empowered CNAs were perceived to have effective work procedures, to have enough time and staff to provide care, to support and work well with other CNAs, and to cooperate with the nurses.

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We all know most people would rather receive long-term care services at home than in a facility. But did you know that baby boomers – at least, most of those who responded to a recent survey – would rather be helped by a paid professional than a family member?

A survey of 1,011 middle- and upper-middle-income people between 50 and 70 years of age found that about half (49 percent) want to be assisted at home by both relatives and professionals. Just over a third (35 percent) wanted care at home from professionals only, while only 7 percent wanted just family members to assist them at home. The rest (about 8 percent) said they’d prefer to go into a nursing home.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org