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“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

“Offering affordable health care coverage is an effective way of improving the quality of long-term care services by improving the quality of direct-care jobs. I’m glad to see this strategy getting more recognition from researchers and policymakers,” says Carol Regan, Director of PHI’s Health Care for Health Care Workers campaign.

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.

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If you’re having some doubts about whether public perception of direct-care workers is improving, a recent run of insightful stories in local papers may give you some hope.

Two stories in Vermont papers, one in the April 7 St. Albans Messenger and one in the April 4 Brattleboro Reformer, covered a new study about the state’s growing direct-care worker shortage. Both amplified its message and recommendations, stressing the need for higher reimbursement rates to long-term care providers, so they can increase pay and benefits for direct-care workers. “If employers are having trouble now with hiring and retaining workers, we’re really going to see a shift in the next 10 to 12 years as the baby boomers turn 75 and older,” said Alexandra Olins, PHI’s northern New England regional director, in the Messenger article.

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One step toward alleviating the geriatric caregiver shortage that was the subject of a recent Institute of Medicine report and Senate hearing would be to pass a bill that Senators Barbara Boxer (D-CA) and Susan Collins (R-ME) introduced into the Senate last month.

The Caring for an Aging America Act of 2008 (S. 2708) would expand career ladder programs for direct-care workers and other caregivers, funding $4 million worth of additional training per year in fiscal years 2009 through 2012 and $3.5 million in 2013. It would also create a loan repayment program for physicians, psychologists, physician assistants, clinical nurse specialists, nurse practitioners and social workers who agree to work for two years in a long-term care setting and an advisory panel to recommend more ways of strengthening the health and long-term care workforce.

The bill is endorsed by a number of powerful associations, including the American Geriatrics Society, the National Committee to Preserve Social Security and Medicare, National Council on Aging, Alzheimer’s Association.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

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Martha Stewart segued from living to assisted living today at a U.S. Senate Special Committee on Aging hearing today, talking about her experiences as a caregiver for her mother.

The hearing explored the growing shortage of geriatric care workers and the need to better support family caregivers, which was the subject of an Institute of Medicine report released two days ago.

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“It is clear that a change in culture is needed – that both health care workers and health care organizations need to change the way they think about direct-care workers and, in particular, that the direct-care workers need to be seen as a vital part of the health care team,” says Retooling for an Aging America: Building the Health Care Workforce, a new report from the Institute of Medicine (IOM). The institute is part of the National Academy of Sciences.

The report, from the IOM’s Committee on the Future Health Care Workforce for Older Americans, also calls for concrete improvements in the quality of direct-care jobs. It advocates a three-pronged approach:

• More, and more effective, education and training;
• Increased wages and benefits; and
• Improvements to the work environment, such as empowerment strategies and culture change.

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