The first case study profiles the Edgewood Centre, a family-owned long-term care facility in Portsmouth, New Hampshire.

Like all of the facilities chosen for PHI case studies, Edgewood embodies PHI’s “quality care through quality jobs” tagline by maintaining a broad range of supports for its direct-care staff.

Strong Practices, Strong Outcomes

The Edgewood case study explains how the facility — with PHI’s assistance — introduced several programs to improve the quality of their direct-care workers’ jobs.

For example, Edgewood’s overall approach to communication has changed as it has adopted the PHI Coaching Approach^SM. Edgewood has also implemented the practice of consistent assignment, which benefits residents just as much as it does workers.

The Edgewood case study includes data proving that those practices work: Staff turnover and callouts by employees have both decreased over the last few years, while staff satisfaction is extremely high.

Such quantitative data will be an ongoing feature of The Business of Caregiving case studies.

“While it is often challenging to track outcome data, the organizations profiled all have some solid evidence of success in their workforce development efforts,” said Marcia Mayfield, PHI director of evaluation.

Multimedia Components

The Business of Caregiving has several multimedia components to accompany the case studies, including podcasts and picture galleries, all of which will be posted to PHI’s Training & Organizational Development Services website.

PHI will release more case studies in the coming months.

The case study series was funded by the Hitachi Foundation. Hitachi was also instrumental in funding PHI’s ongoing series of best practices in long-term care.

– by Matthew Ozga

Guest columnist Nancy Hooyman

A guest column by Nancy Hooyman, a gerontology professor and dean emeritus at the University of Washington’s School of Social Work.

As a Council on Social Work Education representative on the national Eldercare Workforce Alliance (EWA), I am impressed by direct-care workers’ strong presence and how they ensure that their priorities are heard.

The alliance — involving a range of professions, constituencies, and families who care for older adults — seeks to address the need for a better-prepared and more robust eldercare workforce for the 21st century. We seek consensus across disciplines, among at least 75 percent of our members, for legislative action because we believe that what benefits one stakeholder group will benefit all, even if indirectly.

Because of my experience with EWA, I have become increasingly concerned that social workers — often members of interdisciplinary teams of medicine, nursing, and pharmacy — have generally failed to partner with direct-care workers.

Yet in long-term services, social workers and direct-care staff are often the providers who interact most with older adults, sharing the goal of quality care but typically not building on our interdependence.

Work Undervalued, Workload Heavy

Such partnering is critical to address the crisis in eldercare. Both formal and informal sectors provide essential care work that is undervalued by society.

This work is undervalued in part because elders are often socially invisible, the “least desirable and lowest status clients.” In addition, the intersecting forces of ageism, sexism, racism, and classism lower the status of informal and formal geriatric care providers.

Women predominate among the three types of caregivers — social workers, direct-care workers, and informal caregivers (usually family members).

The salaries of geriatric social workers, most of whom are female and many nearing retirement, are lower than other fields of practice; those of direct-care workers, the majority of whom are women of color, are barely enough to live on. Informal caregivers experience few economic rewards, and in fact, often give up paid employment to care for family members.

All three carry disproportionately heavy workloads, involving physically and emotionally challenging tasks. Given these shared characteristics, it is especially puzzling that social workers are rarely advocates for, or partners with, direct-care workers.

Benefits of Collaboration Overlooked

This failure results partially from professional socialization of social workers.

Professional identity, while essential, can create “blinders” to others’ contributions. Social workers are trained that professional education is essential for quality eldercare. Some refer to direct-care staff as paraprofessionals, implying “less than.” Social workers often invest energy to elevate their status in interdisciplinary health care teams, but distance themselves from lower-status workers.

Yet effective collaboration between geriatric social workers and direct-care staff, the “eyes and ears” of long-term services, is essential for quality elder care.

Since elders and families are more likely to be satisfied with care by competent direct-care staff who feel valued, less hierarchical models of supervision that enhance direct-care workers’ decision-making autonomy would likely benefit all providers. However, the potential for such collaboration is rarely discussed in social work curriculum, particularly compared with the time devoted to team building with higher-paid, higher-status providers.

Admittedly, some social workers, especially in skilled nursing facilities, do recognize the value of direct-care workers and partner as advocates for this type of systemic change. Undoubtedly, innovative team models of social workers and direct-care staff exist and could be infused into social work curricula.

Sharing Partnership Models

I am eager to learn of such collaborative models to disseminate through our Center’s curriculum change initiatives. If you have collaborative models to share, please post your comments or e-mail me directly.

– by Nancy Hooyman

Co-Principal Investigator
Council on Social Work Education’s Center for Gerontological Social Work Education

Dean Emeritus and Hooyman Endowed Professor in Gerontology
University of Washington School of Social Work

Working family caregivers potentially cost U.S. employers an estimated $13.4 billion a year — or possibly more, if the employee provides care to a spouse or younger family member.

“This report highlights the tremendous economic cost to our nation due to the toll that family caregiving takes. This cost is directly linked to the inadequacy of our current eldercare services programs and the instability in our direct-care workforce,” said PHI National Policy Director Steve Edelstein.

“Over the coming decade, this cost will grow geometrically unless we take steps now to build an adequate workforce to meet both the current and growing future demand for long-term services and supports,” he said.

The study, entitled “Working Caregivers and Employer Health Care Costs: New Insights and Innovations for Reducing Health Care Costs for Employers,” examines the relationship between family caregiving, caregivers’ health status, and employer health costs.

Corporate Eldercare in Tandem with Wellness Programs

The report concludes with the recommendation to supplement corporate eldercare services with corporate wellness programs to benefit both employees and employers.

Corporate eldercare services are typically offered through Employee Assistance Programs that provide information and referral services to eldercare resources in the community, including respite care, home care, and other services and supports. These services are declining, according to the Society for Human Resource Management. Only 11 percent of corporations provided this service in 2009, down from 26 percent in 2006.

Corporate wellness programs, by contrast, are on the rise because they help to hold down health care costs, the researchers report. Among their suggestions for corporate wellness programs, which are designed to reduce stress and prevent disease, is to develop decision support systems that provide information about the best services for caregivers and their older relatives.

Family Caregiving Takes a Toll

The joint report, released in February 2010 by the National Alliance for Caregiving, the University of Pittsburgh Institute on Aging, and MetLife Mature Market Institute, also found that employees providing eldercare were more likely to report:

• fair or poor health in general
• depression, diabetes, hypertension, or pulmonary disease, regardless of age, gender and work type
• having greater health risk behaviors such as smoking and higher alcohol use
• finding it more difficult than non-caregivers to take care of their own health or participate in preventive screenings
• missed days of work

– by Deane Beebe