The report, entitled “Advancing Home and Community-Based Services: Transforming Policies, Programs, and Service Delivery in Long-Term Care,” (pdf) contains articles by national long-term care experts, including articles on the history of long-term care, trends toward consumer-directed care, and the long-term care workforce.

The article “Strengthening the Direct-Care Workforce: Preliminary Recommendations from a National Panel of Experts in Long-Term Care” highlights the preliminary findings of a national panel convened by the Benjamin Rose Institute on Aging to “enhance the capacity of both the direct-care workforce and family caregivers to provide quality care.”

The national panel addressed four key issues:

• supply of direct-care workers and family caregivers;
• readiness or capacity of both direct-care workers and family caregivers to provide care;
• retention of direct-care workers and family caregivers in their roles; and
• quality or outcomes of direct-care workers’ and family caregivers’ care.

Increasing Supply

To increase the supply of direct-care workers and family caregivers, the panel highly recommends continuing the expansion of consumer-directed care programs. It also suggests drawing on these labor sources to build the direct-care workforce:

• immigrant populations;
• displaced workers over 55 years old who lost jobs in the current recession; and
• people with developmental disabilities.

Improving Worker Capacity

To better prepare direct-care workers for their jobs, the panel recommends the following:

• increase the federal and state training requirements for direct-care workers;
• expand training and education programs; improve their design, content, and delivery; and evaluate their effectiveness;
• design curricula around the core competencies needed;
• build training partnerships; and
• train family caregivers and develop and test models in which direct-care workers provide the training.

Retaining Workers

To improve the retention of direct-care workers, the panel advises improving wages and benefits as well as career advancement opportunities. Better supervision was also suggested as a proven strategy that helps keep direct-care workers on the job.

The panel addresses the relationship between staff turnover and the continuity and quality of care. It recommends tracking staff turnover and retention and disseminating and replicating best practices for retaining staff.

Best Practices

Several innovative practices that aim to improve the recruitment, training, and retention of direct-care workers across the spectrum of facility- and home- and community-based service are showcased in PHI’s Best Practice Profiles.

The Public Policy & Aging Report’s Winter/Spring 2010 issue was sponsored by the Benjamin Rose Institute on Aging.

– by Deane Beebe

“A Celebration of Caring” (pdf) is the theme of the all-day conference, which is being co-sponsored by the Arizona Gerontological Nursing Association.

According to Henry Schemper, the ADCWA’s program director, the conference is intended to “recognize the vital contributions of professional caregivers in the lives of the elders in our state.”

Conference Agenda

The conference will cover a wide variety of topics, including:

• The dangers of bed rest
• Understanding dementia
• Compassionate communication
• Conflict resolution

Attendees will be asked to follow either the “Care Knowledge” track or the “Empowering the Caregiver” track.

Additionally, the award for the 2010 Professional Caregiver will be presented to the most outstanding caregiver of the past year.

Participants are eligible to receive up to six continuing education units (CEUs) for attending the entire conference.

For registration information, contract Henry Schemper at henryschemper@gmail.com.

– by Matthew Ozga

Mary Jane Koren

Modern Healthcare’s August 16 issue features a commentary on the many ways that consistent assignment benefits nursing homes and residents, written by Mary Jane Koren, M.D., M.P.H., chair of the Advancing Excellence in America’s Nursing Homes campaign.

Koren, a geriatrician and vice president at The Commonwealth Fund, explains in “Predictable Scheduling: Nursing Homes Can Boost Quality, Bottom Line with ‘Consistent Assignment’” that when a nurse aide routinely cares for a nursing home resident, it improves the quality of care and is cost-effective.

Relationship between Consistent Assignment and Quality

Consistent assignment is one of the targets identified by Advancing Excellence in America’s Nursing Homes, a national campaign to improve the quality of nursing home care. Participating nursing homes set quality targets, and the campaign provides tools to measure progress and achieve goals.

The campaign data shows that nursing homes that have made inroads in improving quality outcomes are often facilities “with low staff turnover and…rely on consistent assignment,” Koren writes.

For example, she explains that when an aide develops a relationship with a resident through consistent assignment, the use of physical restraints can decrease and the development of pressure ulcers can be reduced. Ongoing relationships allow aides to observe and report potential medical problems, thus reducing costs.

Since residents rate relationships with caregivers as important, Koren says that nursing homes that employ consistent assignment have a “competitive edge in a tough market.”

“The PHI team has coached many nursing homes to implement consistent assignment,” said PHI Director of Training and Organizational Development Services Susan Misiorski.

“I can’t emphasize enough how critical this practice is to ensuring high job satisfaction, high resident satisfaction, and quality care outcomes,” Misiorski said.

Case Study on Consistent Assignment

Consistent assignment is one of the practices featured in a recently published PHI case study that highlights the outcomes achieved by the Edgewood Centre in Portsmouth, NH.

– by Deane Beebe

This is the third consecutive year that the Senate has unanimously approved a resolution to designate a specific week to honor direct support professionals. The resolution (pdf) was sponsored by Sen. Ben Nelson (D-NE) and had multiple co-sponsors.

A dozen states are also recognizing Direct Support Professionals Recognition Week this year.

Advocacy Planned

The American Network of Community Options and Resources (ANCOR) and United Cerebral Palsy (UCP) are calling on direct support professionals, self-advocates, and family members to “Call on Congress” on September 14 to let them know about the need for better wages for community residential direct support professionals.

The groups are urging that members of Congress support the Direct Support Professional Fairness and Security Act (H.R. 868), which would amend Title XIX of the Social Security Act to provide funds to states to enable them to increase the wages paid to targeted direct support professionals in providing services to individuals with disabilities under the Medicaid program.

ANCOR is sponsoring a Governmental Activities Seminar and a “Direct Support Professionals to DC” event from September 12-14. The three-day event will culminate with visits to members of Congress on the final afternoon.

Providers are encouraged to bring their direct support professionals with them to Capitol Hill. Registration information is available online.

ANCOR has also provided 10 ideas (pdf) for events and other actions to celebrate Direct Support Professionals Recognition Week.

– by Deane Beebe

Jack Mills

A guest column by Jack Mills, Executive Director of the National Network of Sector Partners (NNSP), an initiative of the Insight Center for Community Economic Development.

NNSP released a brief last week that provides important lessons for health care providers and direct-care workers. From Hidden Costs to High Returns: Unlocking the Potential of the Lower-Wage Workforce (pdf) reports on the experience of dozens of health care organizations and manufacturing companies.

These employers have found that investments in lower-wage workers directly benefit their bottom lines while their workers move up to better jobs. The brief documents the benefits for employers and provides lessons to help other employers follow suit.

Companies highlighted in the brief include the Visiting Nurse Association of Eastern Massachusetts (VNAEM), which employs 160 people at its home care agency and two assisted living facilities for low- and moderate-income seniors and individuals with disabilities.

Aides Should Get the Pay and Respect They Deserve

As VNAEM CEO Linda Cornell points out, aides are low on the organization’s wage ladder, but they are “the people who have the most responsibility in our organization for the direct hands-on care that our patients and residents receive.” Their performance on the job consequently has a huge effect on service quality and customer satisfaction.

VNAEM’s goal is for every patient and resident to be treated as you would want your loved ones treated, and its ultimate goal is to have everyone in the association recognize and embrace direct-care workers as equal members of the care team. Their approach was that certified aides and nurses’ aides should receive high-quality training, and the pay and respect that they deserve.

Funding from the Commonwealth Corporation’s Extended Care Career Ladder Initiative (ECCLI) supported VNAEM’s early work toward its goals with B&F Consulting in 2004-2005. Over the next two years, VNAEM teamed up with other health care employers and a nonprofit workforce organization, called Employment Resources, Inc. (ERI), to form a collective recruitment and training program for entry-level aides.

Ms. Cornell and her staff had long felt that the standard training required for certified aides and nurses’ aides was too rudimentary to ensure the quality of care that the association wanted to be known for. “In the industry,” she says, “the training did not match what we need…. It was just a bare minimum, no real hands-on training.”

Industry-Focused Workforce Development

Fortunately, ERI was working on an approach to the broader, industry-wide change that Ms. Cornell had in mind. With an ECCLI grant, ERI designed a program specifically tailored for employers who — collectively — hired lots of aides every year. Since so many participated, the program could recruit widely, train large numbers of people, greatly improve the kind of training each candidate received, and yet keep the cost per worker low for each employer.

How the Program Worked

• The program took place at the participating companies’ facilities, so trainees received an immediate, firsthand experience of the working environment.
• A one-on-one assessment of each worker and assessments of supervisors’ and managers’ needs were performed at the outset.
• The employers paid 100 percent of their employees’ salaries while they were being trained.
• The training included various kinds of adult basic education and English as a Second Language, depending on the needs.
• The program paid for transportation and child care when needed.
• Employees who completed each stage of the curriculum got an immediate boost in wages.
• Wages rose from $10 to as much as $16 per hour for completing the full regimen.
• Graduates have become equal members of care teams.
• Several graduates have become Team Leaders and several others have become nurses.

The program also involved and trained supervisors and managers at every level to:

• ensure that the companies know how to get the best results from the newly trained workers;
• get every level to buy into culture change regarding how important all of the workers are at every level; and
• understand how they can better lead.

Given that the need for well-trained employees is common across the health sector, it was logical for ERI to reach out to a number of health care organizations in the region to form a program together. All of the employers worked together to design the training. ERI was at the “center of the wheel” in implementing the design. It brought together other organizations to deliver the services that employers and workers needed.

So-called “sector initiatives” like this one have been shown, in rigorous independent evaluations (pdf), to yield higher earnings and steadier work for participants with low incomes who also face multiple barriers. VNAEM and other employers that participate in sector initiatives receive major benefits too, as documented in other studies and as the brief describes in detail.

Funding for From Hidden Costs to High Returns: Unlocking the Potential of the Lower-Wage Workforce (pdf) was generously provided by the Hitachi Foundation.

A home health aide in training

A new study by Pennsylvania State University researchers found that home health aides who had training are less likely to be injured on the job, and aides who felt they did not have good support from their supervisors were also more likely to suffer injuries.

The researchers also concluded that home health aides who had not experienced on-the-job injuries had a higher rate of job satisfaction and lower turnover “intentions.”

Benefits of Training

The study found that how employees felt about their workplace and training affected the probability of injuries. Employees who felt that their training had not prepared them well enough for the job were three times more likely to be injured than employees who thought that their training prepared them well.

The aides who felt their training prepared them well, not only had lower workplace injury rates, but they were also more likely to rate their organization highly as a place to work and seek services from.

“What this suggests is that investing finances into soft resources can have tangible benefits to organizations,” Deirdre McCaughey, assistant professor of health policy and administration at Penn State and lead author on the study, said in a press release about the study.

“Organizations tend to cut back on spending on soft resources, especially during hard economic times, because there is usually no tangible benefit,” she continued.

Good Supervisor Support

How home health aides perceived the support they got from their supervisors also affected on-the-job injuries, reported the study’s authors. The aides who felt they had poor supervisor support were one-and-a-half times more likely to have one injury, and three times as more likely to have three injuries, than the aides who considered their supervisors to be supportive.

“The study confirms what PHI has found it its own work over 20 years — that well designed adult-learner centered training and good supervisory supports improve retention and job satisfaction,” said PHI National Director of Curriculum and Workforce Development Peggy Powell.

The Penn State researchers analyzed data from the nationally representative 2007 National Home Health Aide Survey, which was funded by the U.S. Department of Health and Human Services and conducted by the Centers for Disease Control and Prevention.

The research findings were reported at the 2010 Academy of Management (AOM) Annual Meeting on August 9.

“Who Needs Caring? We Do! Workplace Injury and Its Effect on Home Health Aides,” was selected as a “Best Paper” for the AOM’s Annual Meeting Proceedings. The conference proceeding article can be purchased for $20 by contacting the AOM Communications and Publishing Coordinator at mdavis@pace.edu.

Visit PHI’s Training and Organizational Development Services website for more information, including PHI Coaching Supervision^SM (pdf).

– by Deane Beebe

The annual event, which has been held since 1981, is designed to “honor residents living in all long-term care facilities,” according to the Consumer Voice’s website.

This year’s Residents’ Rights Week will take place from October 3-9, and will focus on improving residents’ dining experiences.

To promote the event, the Consumer Voice has compiled a cookbook containing recipes that were submitted by various long-term care stakeholders — residents, staff, family members, citizen advocates, and more.

More information about National Residents’ Rights Week, including a downloadable packet of materials to help facilities plan events for the week, are available at the Consumer Voice’s website.

By extending FMAP through the end of 2011, the federal government will distribute an additional $16.1 billion in Medicaid funding to states.

House Votes Along Party Lines

The representatives voted 247 to 161 to approve the state-aid package (H.R. 1586) during a special emergency session held on August 10. Just two Republicans voted to provide relief to the cash-strapped states; only six Democrats voted against the bill.

House Speaker Nancy Pelosi (D-CA) called the representatives back to Washington, D.C., from summer recess to vote on the legislation, after the Senate unexpectedly passed it.

“We are pleased that Congress did the right thing and voted in favor of extending additional funding to states for their Medicaid programs, funds essential to preventing further erosion of coverage and services,” said PHI Government Relations Director Carol Regan.

“However, this was accomplished, in part, by rolling back a temporary increase in food stamps,” Regan added. “We will work with our allies in the Leadership Council of Aging Organizations to restore assistance to low-income families relying on this program.”

Offsetting the Cost

To offset the cost of the state-aid package, several provisions are in place, including accelerating the timetable to halt temporary increases in food assistance benefits.

The $26 billion bill has been called the Jobs Bill, because it also includes $10 billion for states to prevent teacher and other public service worker layoffs due to shortfalls in state budgets.

A chart (pdf) on how the funding will be allocated in each state is available from the Center on Budget and Policy Priorities.

– by Deane Beebe

By the time the law fully takes effect in 2014, up to 15 million uninsured women will be eligible for subsidized coverage, and an additional 14.5 million insured women will see improved coverage and/or reduced premiums.

Low-income women will especially benefit from the law, the issue brief states.

President Obama signed the Patient Protection and Affordable Care Act this past March as part of his administration’s effort to enact national health reform.

Implications for Direct-Care Workforce

Perhaps the most significant provision of the act will be an expansion of Medicaid eligibility to cover adults earning up to 133 percent of the federal poverty level (currently about $14,400 for a single adult).

An estimated 8.2 million uninsured women between the ages of 18 and 64 will be eligible for Medicaid when that provision takes effect in January 2014, The Commonwealth Fund report found.

A significant number of these millions of uninsured women are members of the direct-care workforce, which is 90 percent female, PHI research (pdf) suggests.

Approximately one out of four direct-care workers is uninsured, and many of them would be eligible for Medicaid under the new eligibility rules. The median annual income of direct-care workers is just $17,000; personal and home care aides make an average of $12,000 a year.

PHI has compiled a chart (pdf) on other health-reform provisions that will affect the direct-care workforce.

More Helpful Provisions

The Commonwealth Fund’s issue brief details several other provisions that will benefit women.

Beginning September 23, 2010

• Health plans will be required to cover a wide variety of services without requiring cost-sharing. Those services include screenings for breast cancer, and cervical cancer, as well as osteoporosis screenings for women age 65 and older.

Beginning January 1, 2014

• Insurance companies will be required to accept every individual who applies for coverage, and will be forbidden from charging higher premiums based on gender or pre-existing medical conditions.
• Health plans sold through state insurance exchanges will be required to cover maternity and newborn care.

– by Matthew Ozga

The bimonthly issue of Aging Times features two articles on this topic:

Are We Prepared to Care? — PHI President Steven Dawson explains that as Baby Boomers age, many are retiring from the eldercare workforce, leaving an even greater gap in care. Dawson calls for a system reform to recruit and retain direct-care workers and increase collaboration between the direct-care workforce and social workers.

Vital Yet Undervalued: Recruiting and Retaining Qualified Direct-Care Workers — Nancy Wilson of the Baylor College of Medicine and Jane Bavineau of Care for Elders provide recommendations culled from years of practice, policy work, and research for improving the supply and quality of direct-care workers.

Aging Times also references:

Social Work — Direct Care Partnerships Would Improve Care, a PHI Quality Care/Quality Jobs Guest Commentary by Nancy Hooyman, a gerontology professor and dean emeritus at the University of Washington’s School of Social Work.

Thank You, Iman, Hugo, and All of the Nation’s Other Direct-Care Workers, a personal account by The John A. Hartford Foundation Executive Director and Treasurer Corinne Rieder on how two home health aides make it possible for her elderly parents who have multiple health conditions to live at home. This blog post in the Hartford Foundation’s Health AGEnda calls for putting an end to the Fair Labor Standards Act’s companionship exemption.

The National Center for Gerontological Social Work Education’s newsletter also includes a Direct Care Workers Bibliography (Word doc), a 10-page list of suggested readings on direct-care workers.

– by Deane Beebe