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Direct-care workers participating in a Massachusetts grant program communicated significantly better after getting specialized training in English comprehension, clinical skills, and “soft skills” like communication, peer mentoring, and leadership. “Perhaps the most far-reaching outcome of ECCLI was an improvement in communication,” write Janice M. Heineman and colleagues in The Qualitative Evaluation of ECCLI (pdf), a research and evaluation brief from the Commonwealth Corporation. “It was reported in all organizations and directly affected all levels of personnel, clients/residents, and family members, as well as indirectly affecting operations and quality of care.”

As one nurse supervisor told the researchers: “Communication has improved a lot. I think CNAs don’t feel so much like, ‘You’re the nurse and we can’t contribute anything.’ They feel like, ‘I know there’s something wrong,’ and they’ll come to us more readily with that. And I think we are more receptive because we know they know more.”

ECCLI (short for Extended Care Career Ladder Initiative) was a grant-funded program aimed at improving care quality and direct-care recruitment and retention rates in Massachusetts nursing homes and home health agencies. Each organization offered career advancement opportunities for their direct-care staff, most of which involved specialized training. Commonwealth’s 18-month qualitative evaluation focused on eight homes and three agencies.

The researchers found the clinical training “increased staff understanding of the complex needs of residents/clients and greater competence in providing targeted care,” as well as making frontline workers more inclined to participate in care planning discussions. They also noted that one home health agency reported difficulty matching aides with specialized clinical training with clients who had matching needs, indicating that the skills taught needed to match the needs of the clients served.

Their main conclusions were:

• Opportunities for education and career advancement improve front line workers’ self-confidence, leading to improvements in the quality of resident/client care;
• Offering career ladders and training can make an organization more attractive to potential new employees;
• Career ladder and other workforce development initiatives benefit from the support of upper and middle management;
• Experienced training providers are instrumental to an organization’s ability to reach specific goals;
• English for Speakers of Other Languages (ESOL) and Adult Basic Education (ABE) classes are crucial to developing the long-term care workforce;
• A commitment to achieving improved communication is key;
• Career ladders help establish a “culture of learning” and generate enthusiasm for education;
• Increased wages and elevated titles improve workplace quality - but not without sufficient mechanisms for frontline workers to apply their new skills; and
• Supervisory training is essential to support the transfer of learning from the classroom to the workplace.

Not all the ECCLI organizations are keeping up with the programs started under the grant, the researchers found, but nearly all are maintaining the program’s mission by continuing to find ways of furthering their staff’s professional and educational development.

Elise Nakhnikian is PHI’s Senior Online Editor