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Work-related injuries are extremely prevalent among certified nursing assistants (CNAs) working in U.S. nursing homes, with 60 percent of CNAs suffering an injury in the previous year, according to a study (pdf) by the Research Triangle Institute.

Common injuries included scratches, open wounds, back injuries, black eyes and other bruising, human bites, and strained or pulled muscles. Of those injured, nearly one quarter (24 percent) were left unable to work.

The report, which uses data from the 2004 National Nursing Home Survey and National Nursing Assistant Survey, found that:

• CNAs who were new to a facility, or to the field of direct-care work entirely, were more likely to suffer on-the-job injuries.
• CNAs who had two or more jobs in the prior five years were more likely to be injured. Due to the high turnover rates in direct-care work, three-fourths of CNAs fit that description.
• Poor training and job preparation are strongly linked to higher injury rates among CNAs. More than one-third of CNAs felt that their initial training was inadequate.
• Higher wages are associated with lower CNA injury rates.
• CNAs who said they felt rushed at work were more likely to be hurt on the job. One out of every three CNAs reported not having enough time to help consumers perform activities of daily living (ADLs).
• CNAs working mandatory overtime were more likely to be injured on the job during overtime hours. More than one out of five (22 percent) of CNAs are required to work overtime.

An unexpected finding of the study was that, although assistive equipment was readily available and often used, it was not associated with lower injury rates. The authors conclude that “there are other reasons CNAs are not using the equipment.”

For example, lifting equipment may be too cumbersome to use properly or may require the help of additional staff who may not be available.

Additionally, the study found that positive and supportive organizational cultures in nursing homes promote safer work environments. “The odds of being injured decreased for CNAs who felt respected and rewarded for their work and for CNAs who felt that [their workplace] values CNA work,” the authors wrote.

They suggest that, in order to reduce injury rates even further, facilities should concentrate on providing robust initial and ongoing training, reducing mandatory overtime, and working to lower turnover.

– by Matthew Ozga

Sen. Tom Harkin

Senator Tom Harkin (D-IA) introduced a “sense of the Senate” resolution (pdf) on May 10 expressing the need for a comprehensive approach to expanding and supporting a strong home care workforce, as well as making long-term services and supports affordable and accessible to elders and people with disabilities.

Among the reasons cited for a comprehensive policy approach to meeting the nation’s caregiving needs are:

• Over the course of the next two decades, the number of Americans aged 65 and older will increase from 40 million to 70 million; 70 percent of Americans over 65 require some form of long-term services and supports.
• There are currently 12 million adults, nearly half of whom are 65 or older, who are in need of long-term services and supports due to functional limitations; this is project to grow to 27 million by 2050.
• The current direct-care workforce is well over 3 million strong — with an additional 1.8 million workers needed over the next decade to keep pace with growing demand. This workforce provides 70 to 80 percent of the hands-on care and personal assistance received by Americans who are elderly or living with disabilities or other conditions.
• The quality of home care jobs is poor with low wages, few benefits, high turnover and a high level of job stress and hazards.

The Resolution focuses on a range of policy solutions that include job creation, job quality, workforce training and advancement, pathways to citizenship, and strategies to make care affordable and accessible to consumers and their families.

These solutions are embedded in the Caring Across Generation policy platform and are part of its educational and advocacy efforts.

Caring Across Generations is a campaign to transform long term care in the U.S. for individuals who rely on these services and supports and for the workers who provide home care. PHI is a member of the campaign and serves on its Leadership Committee.

– by Carol Regan, PHI Government Affairs Director

The job quality and wages of home care workers are the focus of recently published articles in LeadingAge Magazine and BrainTrack.

“Ethical Workplaces” Needed

In LeadingAge, writer Dianne Molvig explains the need to create more “ethical workplaces” for home care employees.

“To me, an ethical home care organization is one that cultivates both quality care and quality jobs,” PHI Policy Research Director Dorie Seavey is quoted as saying in the article.

“High quality care is individualized and respectful,” Seavey continues. “High quality jobs provide a family-sustaining wage, affordable health insurance and respect for the worker, who gets excellent training and is allowed to participate in decision-making.”

Molvig uses PHI data to show that wages, retention, and overall working conditions for home care workers must improve if the U.S. hopes to keep pace with the increasing demand for such care.

She cites two organizations — Senior Independence in Columbus, Ohio, and Loretto’s PACE Central New York in upstate New York — as examples of ethical workplaces. Both organizations have invested in their workers in recent years, with positive results.

Revising FLSA Is “Win-Win”

The BrainTrack article, by Beth Panitz, focuses on the debate surrounding a proposed revision to the federal Fair Labor Standards Act (FLSA), which would extend minimum wage and overtime protections to home care workers.

“This revision would be an essential first step to stabilizing the home care workforce and positioning it to meet the demand we see coming,” Seavey is quoted as saying.

“We can raise the floor of these jobs in a way that’s win-win. We can attract more workers to these jobs so that we meet demand, and in so doing, it will improve the livelihood of workers,” Seavey adds.

Opponents of the proposed revision have argued that it will lower care quality by making it more expensive for home care companies to employ workers for 40 hours or more a week, which they say is necessary to establish care continuity. Seavey, however, told Panitz that “the notion that you get the best care when you have one aide working more than 40 hours a week is very questionable.

“We need a more modern approach to what continuity of care means,” Seavey added.

– by Matthew Ozga

Caring Across Generations logo

Caring Across Generations, a multi-stakeholder effort to promote quality care, is hosting a legislative town hall on Capitol Hill on May 21.

Two short panels will discuss:

• protecting current programs such as Medicaid, Medicare, and Social Security; and
• implementing future policies that will build a quality direct-care workforce to support America’s families in meeting care needs across generations.

PHI Government Relations Director Carol Regan will frame the panel discussions, which will include workers, consumers and employers.

Senator Tom Harkin (D-IA) and other members of Congress have been invited. Harkin recently introduced a Sense of the Senate Resolution that commits policymakers to addressing America’s caregiving needs, including quality direct-care jobs and accessible home- and community-based services.

Please join PHI for this important forum on creating a caring economy — and invite your member of Congress and their staff to attend.

The one-hour program takes place in Room 902 of the Hart Senate Office Building and starts at from 11 a.m.

– by Karen Kahn, PHI Director of Communications

An article in the May/June issue of LeadingAge Magazine highlights the challenges and rewards involved with managing ethnic and religious diversity in long-term care organizations.

Written by Jane Sherwin, the article quotes several experts in the field, including PHI Organizational Change Consultant MariaElena Del Valle.

“Workforce diversity needs to be made a priority,” Del Valle says in the article. “We have to acknowledge that the world has changed.”

Del Valle highlights her experiences working with Independence Care System (ICS), a New York-based managed long-term care plan (and PHI affiliate).

“As ICS grows, so does the diversity of its population,” Del Valle says in the article. “There are Russians, Chinese, and Koreans, and the staff needs to be culturally competent, so the organization will seek to use existing staff personal networks to reach out to new employees that understand the language and the culture.”

To learn more about how PHI can help your organization address cultural diversity, check out the PHI Coaching & Consulting Services website.

– by Matthew Ozga

A new report by the Older Women’s League (OWL) expresses support for a proposed revision to the Fair Labor Standards Act (FLSA) that would extend basic wage protections to home care workers.

The report, Women and the Workforce: Challenges and Opportunities Facing Women as They Age, examines the effect of the current job market on women aged 40 and older.

In the report’s “Policy & Legislative Recommendations” section, OWL states that FLSA should be amended “to extend basic labor protections, including minimum wage and overtime premium pay, to home care workers.”

Elsewhere, the report uses PHI data (pdf) to explain that ensuring quality jobs for direct-care workers is an important women’s rights issue; nearly 90 percent of direct-care workers are female, and their average age is 42.

Additionally, OWL’s report cites Partners in Care, the nation’s largest home health agency, as a model workplace for direct-care workers for its training and certification programs.

– by Matthew Ozga