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“I can honestly say that I love being a Shahbaz, and so do my fellow Shahbazim,” Edna Hess told the senators at a July 23 U.S. Senate Special Committee on Aging hearing.

Hess worked for years as a CNA at the Lebanon Valley Brethren Home in Palmyra, Pennsylvania, becoming a Shahbaz (the Green House® name for direct-care workers) when the home converted to the Green House® model nine months ago. Since then, she told the committee, not a single Shahbaz has left. “This a big improvement over my facility’s 23 percent annual turnover rate for nursing assistants, and an even bigger improvement over the national turnover rate for nursing assistants, which I understand to be slightly over 70 percent per year.”

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Judging by a couple of recent articles in Canadian papers, the issues affecting direct-care workers don’t change much when you cross the border.

A July 25 article in the Prince George Citizen describes a British Columbia public relations campaign that aims to generate interest in direct-care work as a career, which was spurred by “a critical need for care aides and home support workers to care for B.C.’s elderly.”

The article says more than 1,500 qualified graduates are needed immediately to fill current positions in nursing homes, assisted living, and home care. To meet fast-growing demand, the government plants to complete 5,000 new long-term care beds and assisted living units by the end of the year, creating the need for more workers.

The $160,000 B.C. Cares Campaign includes a student loan forgiveness program.

And a July 4 article in The Canadian Press called on Ontario to “turn its understaffed, institutional long-term care homes, where residents are more likely to be restrained and medicated, into small community homes where staff have the time to drink coffee with their elderly charges.”

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According to a recent Swedish study, violence against caregivers is often underreported in nursing homes because the caregivers accept attacks as excusable and an unavoidable part of the job. At the same time, violent acts may sometimes be overreported. The problem is that “violence is in the eye of the beholder,” making it hard for caregivers to know what should and should not be reported.

“Violence in Nursing Homes: Perceptions of Female Caregivers” reports on the results of a study of 41 female members of the nursing staff at three Swedish nursing homes, including eight nursing assistants. The caregivers were asked to react to a vignette in which a male resident being helped by a female caregiver suddenly screams loudly, shakes his fist, calls her derogatory names and scratches and pinches her until a colleague comes to help her.

The caregivers generally considered acts to be violent only if they are intentional, so they generally excuse them in people with dementia. “As long as they are confused…and is in some kind of other world, then I cannot consider it as violence,” one said. And if a resident is not aware of who the caregiver is and does not direct the violence toward that individual, they are less likely to consider it violence.

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A recent “listening session” on the direct-care workforce for Wisconsin legislators demonstrated the power — and the limitations — of capturing lawmakers’ attention with personal testimonials.

Family members attested to the importance of paid caregivers, employers discussed the increasing difficulty of recruiting enough workers, and direct-care workers talked about the difficulty of surviving on their wages as gas prices and other expenses increase.

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A profile of Alice Hedt in one of the leading magazines for long-term care providers praises her ability to work well with providers without compromising her standards. That rare talent, says the article, has won the nursing home consumer advocate praise from “an industry she frequently seems to tweak.” The article ran in the July issue of McKnight’s Long-Term Care News & Assisted Living.

“She has very strong management skills and high expectations, but at the same time is very kind and forgiving. She’s soft-spoken but strong-willed. She doesn’t have a mean bone in her body,” said NCCNHR founder Elma Holder of Hedt, who is now the group’s executive director.

NCCHNR, which advocates for minimum federal staffing standards for nursing homes, stresses the importance of proper workplace systems and supports for nursing assistants.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

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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