Jobs to Careers: Promoting Work-Based Learning for Quality Care improves skill-building and career advancement opportunities for low-wage workers in a range of healthcare positions.

Through building partnerships between employers, educational institutions, and community organizations, Jobs to Careers seeks to “expand and redesign systems to create lasting improvements in the way that institutions train and advance their frontline workers.”

The $15.8 million program, also supported by the U.S. Department of Labor’s Employment & Training Administration, has provided grants to 17 organizations nationwide. These include Portland Community College in Oregon, for a project to enhance skill and career development for pre-licensed direct-care workers in assisted living facilities; and Capital Workforce Partners, a Connecticut-based Workforce Investment Board, for work to improve clinical skills, job readiness, literacy, and awareness of career and wage advancement opportunities among Certified Nursing Assistants and other long-term care workers.

The Critical Impact Award was presented at the annual conference of The Council on Foundations, an association of foundations and corporations with a mission to promote responsible and effective philanthropy.

Importance of Training and Career Advancement

By recognizing the joint work of The Robert Wood Johnston Foundation and The Hitachi Foundation, The Council on Foundations emphasized the importance of a key issue — namely, the need to improve training and advancement opportunities for frontline healthcare workers, who play an essential role in the delivery of quality care to consumers.

In another effort, the Hitachi Foundation currently supports PHI’s work to document employment strategies that strengthen opportunities for low-income individuals.

PHI’s work under this grant includes producing case studies of “high road” employers that are expanding opportunities for frontline direct-care workers.

– by Brian DiPaolo

Contact: Alex Olins
PHI Northern New England Director
Phone: (802) 655-4615
Email: aolins@PHInational.org

Rewarding Skill and Improving Care
New initiative provides career advancement opportunities for direct-care workers in Vermont

Burlington, VT — Few issues are more important to people today than health care. Both from a personal and societal perspective, Americans are deeply concerned about what the future holds for them when it comes to health care. In many states, the growing needs of an aging “baby boomer” generation are creating an enormous shortage in qualified direct-care workers, who provide most of the “hands on” home and community-based care that elders and people living with disabilities depend upon.

Challenged by this critical need, the Vermont Department of Labor, with funding from the DOL’s Workforce Education and Training Fund, is supporting a unique education and career ladder training program for 65 Personal Care Assistants (PCAs) at four sites in northwestern Vermont:

• VNA of Chittenden and Grand Isle Counties
• Franklin County Home Health Agency
• Armistead Caregiver Services
• Home Instead Senior Care

PHI — a nationally recognized training and organizational development consulting firm focused exclusively in the eldercare/disability services industry, with a regional office in Vermont for many years— will be serving as project manager of the entire initiative. PHI will be collaborating with the Vermont Department of Labor (DOL), the Northwest Technical Center, the Community College of Vermont, Vermont Adult Learning, and all four community partner sites throughout the project.

“These educational opportunities will be the next steps in what has proven to be a valuable and mutually important collaboration,” said Churchill Hindes, VNA President and CEO. “This initiative will benefit the agencies involved, the trainees who participate in the instruction, and ultimately — and most importantly — the people who will benefit from their skills and caring.”

An Innovative Solution with Growth Opportunities

The initiative will address the state’s shortage of direct-care workers with the development of a career ladder training program to improve workforce retention and ultimately, it is hoped, increase the number of PCAs available to care for Vermont’s aging population. The program will assist incumbent workers to advance in their health care careers, and allow participating workers and organizations to:

• Earn while they learn. PCAs will be paid for at least 50 percent of their time while in training—a critical component of success in incumbent worker training programs for low-wage workers.
• Work toward meaningful promotions and raises: At some locations, training will enable a PCA to be promoted to PCA II. At other sites, training will enable a PCA to be certified as a Licensed Nursing Assistant (LNA), with the requisite increase in wages.
• Participate in a flexible and robust learning opportunity. Each provider will provide a customized training program for its workers.
• Encourage a more diverse group to enter health care professions. Non-native English speaking participants will be able to take contextualized ESOL classes at their worksite, in conjunction with their clinical skills classes.
• Improve workforce retention.

The CareWell curriculum, a 40-hour course developed by the Visiting Nurse Association (with support from the Community of Vermont Elders through their Better Jobs Better Care initiative), will be a cornerstone of the PCA training. PHI, in addition to its role as project manager, will also be providing its “Coaching Approach to Communication” training at all sites.

“One of the fastest-growing occupational areas in Vermont over the next 20 years will be in direct-care services,” said Greg Voorheis, Senior Grant Administrator for the Vermont Department of Labor. “The state’s Workforce Education and Training Fund grant to PHI creates the opportunity for multiple long-term care employers to hire well-trained direct-care workers who will be participating in the development of a career ladder.

“PHI’s leadership in this work will benefit not only long-term care employers, but many direct-care workers already in the field — or individuals who aspire to work in the field. And, most importantly, their work will improve the quality of health care provided to individuals. We look forward to sharing what we learn with others,” Voorheis concluded.

The program, which was officially launched in early June, will conclude in June of 2010.

For more information about this project, call Alexandra Olins, PHI Regional Director, Northern New England, at 802-655-4615.

This is the second in a series of PHI Expert Interviews, which bring you insights from four senior PHI staff. They’re an impressive group – among the nation’s leading experts on long-term care’s direct-care workforce – and collectively they’ve spent decades studying the challenges facing the workforce and how to address them. We think you’ll be interested in what they’ve learned.

Peggy Powell is one of the founders of Cooperative Home Care Associates, the worker-owned home health agency that started PHI, where she served as director of education. Since joining PHI in 1991, she has worked with CHCA and other employers to develop strategies for recruiting, training, supervising, and supporting direct-care staff.

One of those strategies, peer mentoring, is gaining in popularity – and no wonder. Done right, a peer mentor program helps new direct-care workers get oriented to the job and the organization, bolstering their skills and their confidence. It also creates a career ladder for experienced workers.

And that’s not all, as Peggy has learned.

Moving away from the blame game

Since helping CHCA launch its peer mentor program in 2002, Peggy has helped turn the program into a published curriculum and adapted it to two other organizations. The PACE CNY program at Loretto, a large, multi-setting elder services provider in central New York, started peer mentoring with funding from a grant to improve workforce practices. The Center for Nursing and Rehabilitation (CNR), a Brooklyn nursing home with subacute care and short-term rehabilitation units, established peer mentoring as part of its culture change initiative.

CHCA’s leaders got interested in peer mentoring when they looked at why turnover was so heavy during the first few months their aides spent on the job and concluded that new workers needed more support.

“We wanted to move away from the blame game,” says Peggy. “You often had the newer workers complaining that they needed more support. Meanwhile, the coordinators complained that the new workers needed too much of their time – and that they didn’t seem to know the procedures and tasks they should have learned in training. That led the coordinators to blame the trainers. And then the trainers blamed the recruiters, for not screening candidates adequately.

“The idea behind the peer mentor system was that the problem was with the system, not with the people. People need time to learn their jobs and to learn the culture of the places where they work. New workers need someone they can ask questions of – someone they can trust.”

If you’ve seen one program, you’ve seen one program

Each mentor program needs to be tailored to the needs of the organization, Powell stresses. “I always say: If you’ve seen one mentor program, you’ve seen one mentor program.”

Before an organization writes job descriptions or starts recruiting its mentors, Peggy and her PHI colleagues interview staff at all levels, from aides to operations managers. In part, they’re generating buy-in and making sure everyone understands how peer mentoring will work, but they’re also gathering valuable information about particular needs that may affect how the program is structured.

For example, both CHCA and PACE have used their mentor programs to change the way they assigned cases. Rather than assigning a challenging case to a new aide and expect her to manage the case competently on her own, they alert the aide’s mentor, to make sure someone will check in to offer support and answer questions. In the past, Peggy says, tough cases contributed to high turnover rates amonth new aides at both organizations. “They’d get overwhelmed and they wouldn’t have anyone to turn to for advice, so they would just leave.”

To handle the volume of new workers at their fast-growing organization, CHCA also amended its program to create a two-tiered mentor structure. Level 1 mentors work full-time as aides and do 10 hours of mentoring a month. Level 2 mentors work as mentors full-time and handle more complicated cases.

Key elements

PHI has identified 10 elements of a formal peer mentor program. Peggy singles out five as crucial:

• Create a clear program design. Explain the role mentors will play and how it fits in with your existing orientation.
• Get buy-in from management. Make sure the mentor program will solve a business problem in the organization – e.g., improving job satisfaction or reducing turnover – to ensure that management invests the time and money needed.
• Compensate mentors adequately, either through a raise in their hourly wage or through a monthly stipend. “A lot of organizations will say, ‘We’ll pay 20 or 25 cents more an hour,’ because that’s all they feel they can afford – and because they’re not really looking at the cost of turnover,” says Powell. She recommends that raises be at least 50 cents an hour.
• Train and support mentors adequately. PHI starts its mentors with a two-day training session, followed by two booster sessions within the first two months. In addition, the program director checks in regularly to offer support as needed.

The payoff

“You can get a mentor program up and running in four to six months, and if you do it right you’ll see changes very soon,” says Peggy.

Done right, she adds, peer mentoring helps residents and other staff, not just direct-care workers. “A good peer mentor helps the relationships thrive between the residents, the nurses, the other workers, and the aides. They help the system achieve its goals around quality care and staff satisfaction.”

At CNR, a survey of workers, residents, and family members before and after the intervention found that ratings rose significantly on many key indicators. Residents and their relatives were much more likely to recommend CNR to others, for example, and far more satisfied with the “friendliness and skill of CNAs.” And in the PACE program, the turnover rate for new hires dropped from 48 percent in the first six months in 2005, just before the program was implemented, to 12.5 percent in 2007.

Peggy points to ECCLI, LEADS, and the Foundation for Long Term Care as initiatives that have fostered successful peer mentor programs.

Developing leaders

One unexpected bonus of peer mentoring for Peggy has been its capacity to create new leaders within an organization. “The outcome is a more confident and empowered worker who’s willing to take greater risks, to grow,” she says. “As these mentors begin to see the growth in people they’ve worked with, it allows them to grow in their own self-confidence about what they’re capable of doing.

“At CHCA, after about a year and a half of CHCA organizing their support meetings, the mentors decided they could do it themselves. Now they organize every meeting, with a check-in on where people are at and a skills piece where people are learning something new. It’s been the most amazing thing for me to see.”

Peggy built that new knowledge into her recent collaboration with CNR, whose peer mentor program is called Mentors as Leaders. The home, which had restructured its units into neighborhoods, wanted CNAs to be leaders in its culture change initiative as well as mentors for workers in the neighborhood.

“Peer mentoring can be a powerful tool for building leaders,” says Peggy.

Interview by Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

Recommendations for Establishing a Credentialing System for Iowa’s Direct Care Workforce,

The report documents work to be done to implement recommendations published by the task force in December 2006.  Work began on the project last month.

Iowa’s proposed three-tiered credentialing system is intended to ensure that all direct-care workers are adequately prepared for the job. It also aims to make workers’ duties and qualifications clear to the consumers and family members who hire them, to acknowledge their special skills, and to correct the inequities of the current system, which requires training in some settings but not in others even when the same set of services is delivered in both.

The report includes 17 recommendations, a timeline, and detailed lists of criteria, qualifications and resources needed to create:

• A standardized curriculum for all new direct-care workers, regardless of setting
• Educational equivalency with other health care professions
• Standardized qualifications for educators and trainers
• Continuing education requirements for direct-care workers, educators and trainers
• Governance

It also includes an extensive list of specialty skills that should be eligible to receive “endorsements.”

A 16-page implementation plan (pdf) will guide the group’s work, with adjustments as needed as the project progresses.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

A nine-page overview lays out how and why the project came into being, the problems affecting the direct-care workforce, and how awareness of and responsiveness to those problems is changing. The essay is by Robyn Stone (pictured), executive director of the Institute for the Future of Aging Services, and PHI President Steven Dawson. FAS and PHI conceived of BJBC and provided technical assistance to the grantees. Funding was supplied by the Robert Wood Johnson Foundation and The Atlantic Philanthropies.

Among the findings detailed in the issue:

• Direct-care workers across long-term settings identified more pay, improved communication, better supervision, and being treated with respect as the most important things employers could do to improve jobs.
• After accounting for satisfaction with wages, benefits, and advancement opportunities — good basic supervision was most important in affecting CNAs to stay in their jobs.
• There is a positive correlation between CNA job commitment and resident satisfaction.
• After accounting for satisfaction with wages, benefits, and advancement opportunities, good basic supervision was the most important factor behind commitment to the job.
• To improve recruitment and retention of home care workers, jobs should be flexible and provide affordable health insurance for part-time workers.
• A great many of the people who provide paid consumer-directed care for friends and relatives are interested in caring for others as well, even people they don’t know.

There are also reports on the success of two workforce interventions: North Carolina’s WIN A STEP UP program, a multi-faceted program to reduce turnover through incentivized training and improved supervision; and, an experiment in New York and Connecticut proving the value of retention specialists in reducing turnover.

The articles are free to Gerontologist subscribers only. Others must pay $20 per article or $50 to download the entire issue.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

Many previous studies have analyzed nursing assistant turnover within a facility, but few have looked into why workers leave the profession. “Staying the Course: Facility and Profession Retention Among Nursing Assistants in Nursing Homes,” a study published in  the Journal of Gerontological Research Series B: Psychological Sciences and Social Sciences, used data for 2,328 nursing assistants (NAs) from the 2004 National Nursing Assistant Survey to compare the reasons for both.

More than two in five respondents (43%) said they didn’t expect to be in their current job one year later, and one in five (20%) percent said they were actively looking for another job. The six most important reasons given by those who expected to leave their jobs soon were:

• poor pay
• already have a new or better job
• problems with working conditions or policies
• too many residents to care for
• poor benefits
• problems with supervisor

But none of those factors were linked to intending to leave the profession. Nearly half of the respondents (48%) did not expect their next job to be as an NA. The main differences between them and their peers who intended to stay were personal traits such as age, race, and household income. Those who intended to leave the profession had higher levels of education and were more likely to be non-white than those who intended to stay. They were also far more likely to have higher household incomes (more than $50,000 a year.)

 These finding show that “financial compensation and benefits for NAs must be competitive relative to other occupations” to attract and keep an adequate supply of workers, conclude researchers Sally C. Stearns and Laura P. D’Arcy of the University of North Carolina at Chapel Hill.

Their study also demonstrates the need to improve working conditions and the quality of direct-care jobs and to provide more career advancement opportunities within the profession, the researchers say.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

“It’s not viewed that way by society – or, frankly, by many employers – but not everybody can do this job. You have to be smart; you have to be able to problem solve; you have to be flexible and a quick thinker. You also need patience and empathy and creativity. We’re not going to get anywhere in terms of policy advocacy or getting the supports we need in place without clearly articulating that this is a highly skilled job.”

Hewitt is a senior research associate at the University of Minnesota’s Research and Training Center on Community Living. The center’s mission is to support community living for people with intellectual and developmental disabilities – and that has led to a focus on strengthening and supporting the direct support workforce.

“The quality of people’s lives is directly related to the quality of the support that they get, and that support is provided by direct support workers,” says Hewitt. “So a lot of our work is in trying to understand workforce challenges – and, more importantly, trying to develop tools and resources for community providers, to help them improve their retention rates and the competence of their workers.

“Direct support work is not just about keeping people clean and fed and safe. It’s about helping them make friends; helping them evolve relationships; helping them decide what activities in the community they’re interested in and connecting them to those supports. It’s about helping them have a life.”

To improve clients’ lives, you need to reduce worker turnover
The center’s research into the workforce is based on “the premise that people’s lives are better if they have a well-trained and stable workforce, so if you can reduce turnover you can improve lives,” Hewitt explains. “We did a fairly comprehensive study in Minnesota that showed that people who received care in organizations with higher rates of turnover had worse outcomes.”

Hewitt’s colleague Sheryl Larson have conducted a longitudinal study of direct support workers that Hewitt calls “seminal,” interviewing them when they were hired and then again over the course of a year to learn why so many left their jobs within three to six months. Common reasons for departure included:

• Poor wages and benefits;
• Limited, nonexistent or inefficient supervision;
• Conflicts with coworkers; and
• Not having understood what the job entailed when they signed on.

That study led to what Hewitt calls “applied, or intervention, research.” In several studies, Hewitt and her colleagues have tested various interventions aimed at improving those problems to see if they affect turnover rates. The findings, she says, are encouraging: “More and more, our work is showing that organizations can change behavior, culture, and practice in a way that will benefit the workers.”

What employers can do
“Wages and access to benefits really matter. We would be remiss not to say that,” says Hewitt. “But that said, there really are things that organizations can do differently now, without more money, just using the resources they have more wisely, that can change the turnover outcomes within their workforce.

“That’s often very hard for providers to accept, that they create environments in which workers feel devalued, feel incompetent, feel disrespected, and there are things they can do to improve.”

Strategies the center teaches to employers include:

• How to identify and hire the right people for the job, rather than hiring “whoever walks through the door”;
• Realistic job previewing, a technique designed to ensure that people know what the job entails before signing on to do it;
• Effective supervision, through the use of the coaching supervision model and other strategies; and
• Empowering direct support workers by including them more in decision-making.

Sharing knowledge about the workforce across settings
The research and training center is also sharing what it knows about improving direct support jobs through the National Direct Service Workforce Resource Center, a project of the Center for Medicare and Medicaid Services. Hewitt’s group is one of three organizations selected (the others are PHI and the Institute for the Future of Aging Services) to provide technical assistance to states that are strengthening their home- and community-based direct care workforces.

“We help states either develop policy or programs or improve their understanding of workforce issues,” Hewitt says of the technical assistance providers. “And we spend time together as kind of a think tank. Our time together and our reporting has solidified our understanding that a lot of our issues are the same across the various sectors — intellectual and developmental disabilities, behavioral health, aging, physical disabilities, etc.”

The TA providers are also working on developing a set of recommendations for how to strengthen the direct-care workforce across all home- and community-based settings. As the background for those recommendations, Hewitt and her colleagues from the DSW Resource Center are writing a comprehensive literature review of “what is known about the workforce across the behavioral health, aging, intellectual and developmental disabilities and physical disabilities communities.” The paper, which is due out in late August, will be available at the DSW Resource Center website.

Primarily, the things that we struggle with are similar
In the past, providers and researchers in the field of aging services and physical disabilities rarely mingled with their counterparts in the intellectual and developmental disabilities or mental health fields. Hewitt is glad those days are coming to an end. “We would all do better if we communicated more across the sectors, if we shared ideas and resources,” she says. “From a policy point of view, there are benefits in coming together with a single message from a policy advocacy point of view from across all sectors – and I mean mental health as well.

“Unfortunately, services tend to follow funding, so as long as the funding sources for the different services are doled out from separate silos, the idea that all direct-care workers will be trained the same and treated the same is not realistic.”

The silo effect is “absolutely” the main cause of the disconnect, Hewitt believes, but there have also been significant differences in the way services were delivered. She sees those differences blurring as services for the aging and people with physical disabilities become more home-based and person-centered, catching up to a trend that started about 20 years ago in the intellectual and developmental disabilities field.

Once you’re delivering home- and community-based care and tailoring it to individual preferences and needs, workforce issues tend to converge regardless of what kinds of clients you’re assisting. “Primarily the things that we struggle with are similar: the logistics of finding enough workers, giving them enough hours, getting them where they need to be, getting them trained.”

Another change in aging services that has brought the silos closer, she says, is “the realization that you need an additional skill set and different levels of care to work with people with who have unique needs, like Alzheimer’s.” Many people with intellectual and developmental disabilities who receive long-term care need special assistance in dealing with “challenging behaviors – things like self-injurious behavior, property destruction, responding emotionally to stimuli in a way that is not typical. That’s similar to what can happen with Alzheimer’s,” she notes.

We need to support relationships between workers and the people they assist…
One of the most important things she has learned from her work, Hewitt says, is that “effective direct support is about relationships. I think we try too hard to objectify the work and to put barriers between the relationships. But in the end, it only works for the client if there’s a positive relationship. And if you ask workers why they stay, despite all the barriers — the low wages, the lack of benefits, the often bad or nonexistent supervision, the organizations that don’t respect them — the reason is their relationships with the people they provide support to.

“We have direct support workers who have been working for the same clients for 20, 30 years. These are lifelong relationships that result in those people having better lives. Yet we try to build policies and procedures that deny those relationships.

“I get that employers have to be concerned about liability, but if we stopped hiring people who shouldn’t do this work, we wouldn’t have to worry about that.”

… and we need to support families better
Of course, finding enough of the right people is not always easy – and it will only become more of a challenge as more people need services –unless significant changes are made. “I think we have to make the jobs more attractive, certainly, and do better at reaching out to other pools of potential workers,” says Hewitt. “But at the same time, we have to figure out how to give more support to families who deliver services, so they don’t go bankrupt or become emotionally and physically depleted.

“I think that’s what consumer direction is about: trying to figure out how to get people the support they need within the context of their natural family.”

Interview by Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

“The fundamental problem has to do with the industry’s current basic business model of low-investment, high-turnover,” Dawson adds. “It’s based on the assumption that there’s a virtually endless supply of these workers, but I believe that the era of an endless supply of labor is coming to an end…. The approach to dealing with this new era will instead have to be “high-investment” on several fronts.”

The interview was conducted by Richard Peck, editor of Long-Term Living magazine, for the magazine’s website.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

Now a consultant, Rader has helped pioneer key advances in reducing the use of restraints and finding conflict-free ways of bathing in long-term care. The co-author of Individualized Dementia Care: Creative, Compassionate Approaches and Bathing Without a Battle, which won Book of the Year awards from the American Journal of Nursing in 1996 and 2002, she is one of the founders of the Pioneer Network.

She learned to appreciate the contributions made by direct-care workers early in her career. “I’ve always had a tremendous amount of respect for the work they do, and also for the informal power they have. I might have had the best solution in the world, but if I didn’t have their buy-in, it wasn’t going to get anywhere.”

“I had some ideas, but the bulk of them came from the direct-care workers”
Rader spent about 27 of her 35 years in long-term care as a mental health nurse specialist in Providence Benedictine Nursing Center in Mount Angel, Oregon. “I’m a pretty hands-on person – I like to get in right at the care level,” says Rader. “But I’ve had to pull back and look at systems, because you can’t get the good stuff into practice unless the system supports it.” And most long-term care systems, she found, fail to tap the “absolutely essential information about the residents” that only direct-care workers hold.

In her work to improve care quality at Providence Benedictine, she says: “A lot of the ideas came from the direct-care workers. I learned that the way to succeed in problem solving was by tapping their expertise.”

Take Bathing Without a Battle, a popular video and curriculum co-authored by Rader that teaches caregivers how to transform the way people with dementia are bathed. “I’m just the messenger,” says Rader. “I had some ideas, but the bulk of them came from the direct-care workers.” CNA Cathy House, for instance, was “just a master at figuring out all the possible ways to get people clean.” And CNA Beth Parker not only contributed her own ideas but marshaled those of her coworkers, taking the initiative to teach what she had learned when helping Rader pilot the program to the other aides in her facility’s dementia care units. “Together, they revamped the bathing plans of all the other residents,” says Rader. “They were very creative about how to do it.”

Direct-care workers can be ”very powerful teachers”
Rader brought in CNAs as often as possible to help her teach the bathing curriculum. “I knew I was really doing culture change when I was at a conference and an aide I had worked with was presenting with me, and at the end, the questions were almost all directed at her. It was clear that she had answers I didn’t – she was the one doing it on a daily basis.”

She regrets not having tapped into that expertise earlier in her career, when she was teaching about restraint-free care. “By the time I did the bathing work, I had picked up the resentment direct-care workers had about people who come in to teach them about their work who don’t really understand their work,” she says. Besides, she says, their passion for providing good care and the stories they tell about things that happened on the job can make direct-care workers “very powerful teachers.”

“It’s not easy unless you have a facility that supports the workers”
Bathing Without a Battle is part of the Pioneer Network’s larger mission of making long-term care facilities true homes, replacing the top-down, hospital-style care delivery model with a “person-directed” method of responding to individual preferences and needs.

But person-directed care can only work, Rader says, if direct-care workers are empowered. Bathing Without a Battle is “not that expensive, and the skill base needed is pretty minimal. You can learn it in about a few hours. But it’s not easy to do unless you have a facility that has consistent assignment and that supports the workers to make decisions and act on what they know about the residents.

“If we’re going to provide person-directed care, we need to really listen to what people want; we can’t just impose things on them. For direct-care workers, that means the way that they relate to people is more important than getting certain tasks done at certain times. The workers know when it’s a good day to give someone a shower, or whether they need to try something different than a shower. So rather than make them spend time explaining themselves to the nurse, just let them go ahead and make the adaptation.

“I hear from aides who are criticized for talking ‘too much’ to residents,” she adds. “But if you ask almost anybody who works in long-term care why they do it, they’ll say it’s because of the relationships they have with the residents, the elders. That’s the hub that everything else comes from.”

Interview by Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

Regan wrote one of the papers in A Compendium of Three Discussion Papers: Strategies for Promoting and Improving the Direct Service Workforce: Applications to Home and Community-Based Services. All three offer concrete solutions and list resources for people interested in strengthening the direct-care workforce in home- and community-based care. The compendium was issued by the Rutgers Center for State Health Policy.

The papers include:

• Home and Community-Based Services: Workforce and Quality Outcomes, by Elise Scala;
• What is the Impact of Unions on Quality of Care? by Leslie Hendrickson; and 
• Health Coverage for Direct Care Workers, Emerging Strategies, Regan’s contribution.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org