PHInational.org

Getting real about retention

This is the fourth 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.

When Steven Dawson came out of the workforce development field in 1992 to join Peggy Powell in heading up the Paraprofessional Healthcare Institute, PHI’s sole purpose was to raise funds and provide technical support for Cooperative Home Care Associates. Over time, Steven led PHI into the broader long-term care arena, where its policy and practice experts work with employers and lawmakers to support and stabilize the nation’s direct-care workforce.

Steven has written about the impending direct-care workforce crisis (pdf) and the link between quality jobs for direct-care workers and quality care for long-term care consumers. Through the years, his emphasis has been on creating workplaces that are intentionally re-designed to retain direct-care staff.

“A constantly churning workforce is the enemy of quality care — ask anyone whose mother has had to deal with five different home health aides within a month, or with a blur of CNAs in the nursing home. The industry still manages to attract hundreds of thousands of skilled, caring workers every year, but once hired, these frontline staff are too often treated as if they were invisible. So, of course they leave,” he says. Read the full story

Gathering the Evidence that Makes Progress Possible

This is the third 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.

Marcia Mayfield, PHI’s director of evaluation, helps PHI document its successes for policymakers, employers, funders, and anyone else who needs to know what works and what doesn’t. As she explains it, her evaluation team does three things:

• Helps PHI learn from what it has done, to make its work more effective;
• Documents PHI’s work and measures its impact, “both for our own purposes and to share what we’ve learned with others in the field”; and
• Develops evaluation tools and approaches for use by anyone interested in improving direct-care jobs. For example, providers can use a business investment calculator due out this fall to calculate their turnover costs, comparing that figure to the cost of various retention or culture change initiatives.

Hired last year by PHI  after 12 years as an evaluator for an international women’s  health organization, Marcia says her goal at PHI is “to demonstrate in a measurable way that what we’re doing works. We essentially have to make the business case for the initiatives we’re promoting.”

Read the full story

Tapping the Power of Peer Mentoring

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. Read the full story

Over the next month, the PHI Expert Interview series will 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.

The One Thing You Need to Make Culture Change Work

Sue Misiorski, PHI’s Director of Organizational Culture Change, has been making nursing homes better places to live and work for more than 20 years. A registered nurse, she started her career as a CNA and later became a director of nursing and vice president of nursing for an innovative nursing home chain.

Sue is also one of the pioneers of the Pioneer Network, the people behind the concept of culture change. She was president of the Pioneer Network for three years, and she wrote its handbook on how to implement culture change: Getting Started: A pioneering approach to culture change in long-term care organizations.

The Pioneers have worked hard to keep the concept of “culture change” flexible. They say that it’s a journey, not a destination, and that it can start almost anywhere. In keeping with that philosophy, Sue and her PHI colleagues start with an organizational assessment when they work with an employer, learning about that particular organization’s needs and goals rather than trying to impose a cookie-cutter solution.

But Sue has learned that one thing must be in place before an organization can embark on its culture change journey. Read the full story

“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.

Read the full story

“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