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Recommendations for Establishing a Credentialing System for Iowa’s Direct Care Workforce, (pdf) a recent publication from the Iowa Direct Care Worker Task Force, is a useful tool for advocates in any state who want to create “an accessible, comprehensible, flexible, quality system of education and training for all direct care workers.”

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.

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The July issue of The Gerontologist is devoted to findings from the Better Jobs Better Care research and demonstration project. BJBC, which began in 2002 and ended in 2006, was the largest initiative in the nation ever created to address the high vacancy and turnover rates of direct-care workers by improving the quality of direct-care jobs. The initiative involved changing both public policy and employer practice. Demonstration grants were made to groups in Iowa, North Carolina, Oregon, Pennsylvania, and Vermont.

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. Read the full story

If you want to reduce nursing assistant turnover at your facility, you need to improve working conditions — maybe hire more direct-care staff, give your supervisors management training, or include direct-care workers more in decision making and care planning. But motivating nursing assistants to stay in the profession long-term requires a whole different set of incentives. According to a new study, stemming the flow of workers from the profession will require system-wide changes like higher wages, better benefits, and more career advancement opportunities for all direct-care workers.

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.

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“If I had only one sentence, this would be it: Direct support work is a highly skilled job,” says Amy Hewitt.

“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.

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“There’s really no mystery here,” says PHI President Steven Dawson in an interview about solving the staffing problem in long-term care. “It’s a matter of providing a living wage, healthcare coverage, support, and recognition of what these workers do and providing the training they need to do the job well. It’s a matter of political will.”

“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

“My passion for working with people with dementia, for making life better for them, has been my major motivating factor. But over time, I keep saying to myself: ‘It’s the direct-care worker, stupid,’” says Joanne Rader. “The only way to make the lives of people with dementia better is to improve the working lives of the direct-care workers. We need to put the things in place that let them provide relationship-based care.”

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.” Read the full story