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The newest additions to the PHI National Clearinghouse on the Direct Care Workforce:

No Time to Waste: Recommendations for an Integrated National Plan to Overcome Alzheimer’s Disease — This report offers a detailed strategy for how the U.S. should approach the fight against Alzheimer’s disease in the coming decades. One of the steps recommended in the report is an expansion of the eldercare workforce, including the direct-care workforce. The report argues that direct-care workers should be given competitive wages and benefits and career-advancement opportunities in order to attract more people to the job. Direct-care workers should also receive comprehensive geriatrics training to better serve people with Alzheimer’s. The report was published by the Alzheimer’s Foundation of America in October 2011.

Stayers, Leavers, and Switchers among Certified Nursing Assistants in Nursing Homes: A Longitudinal Investigation of Turnover Intent, Staff Retention, and Turnover — Published in the October 2011 issue of the Gerontologist, this study presents the results of a longitudinal survey of 620 full-time CNAs working in Pennsylvania nursing homes. The survey found that after one year, 85.8 percent of CNAs remained in their jobs (stayers), 8.4 percent switched to another facility (switchers), and 5.8 percent left the industry (leavers). Among switchers, the most-cited reason for leaving their jobs was to pursue other opportunities. Leavers, meanwhile, said they were motivated primarily by emotional distress, low job satisfaction, and a lack of respect from supervisors. The authors note that, even accounting for methodological differences, this turnover rate is lower than previous studies, which use alternative methods and include part-time workers.

Top Management Leadership Style and Quality of Care in Nursing Homes — This study, published in the October 2011 Gerontologist, documents the relationship between nursing home managers’ leadership styles and the quality of care provided in their facilities. The authors found that the “consensus management” style — in which managers solicit input from their employees — had the strongest correlation with a high care-quality standard.

Reassessing Nurse Aide Job Satisfaction in a Texas Nursing Home — This article presents the findings of a job-satisfaction survey administered to nursing aides at Carillon House, a Texas nursing facility. The survey found that the greatest source of nursing aide job satisfaction was from working with residents. At the same time, low wages, a lack of recognition from supervisors, and a dearth of advancement opportunities were among the aspects of their jobs that they liked the least. The study was published in the September 2011 issue of the Journal of Gerontological Nursing.

The PHI National Clearinghouse on the Direct Care Workforce is a national online library for people in search of solutions to the direct-care staffing crisis in long-term care. It houses over 1,000 articles, reports, issue briefs, and fact sheets on the direct-care workforce.

– by Matthew Ozga

The newest additions to PHI’s National Clearinghouse on the Direct Care Workforce:

Improving Job Quality: Direct Care Workers in the US — This paper presents several strategies for improving the quality of direct-care jobs in the U.S. and the U.K. It argues that a “decent public sector investment” in caregivers’ wages, working conditions, career advancement opportunities, and training requirements is necessary to substantially improve job quality. The paper was published in September 2011 by the Center for Economic and Policy Research.

Nursing Home Survey on Patient Safety Culture: 2011 User Comparative Database Report — This August 2011 survey contains data compiled from 226 nursing homes throughout the U.S. The data presents the opinions of nursing home staff regarding resident safety, the incidence of medical errors, and event reporting. The survey was conducted by the federal Agency for Healthcare Research and Quality.

Cost of Turnover in the Direct Care Workforce — This June 2011 report by the Iowa Department of Public Health estimates that statewide turnover among the direct-care workforce cost Iowa $117 million in 2010 alone. That figure is expected to increase as the workforce grows larger; by 2015, turnover will cost $148 million.

The Influence of Nurse Staffing Levels on Quality of Care in Nursing Homes — This study examines the relationship between the certified nursing assistant (CNA) staffing levels and the Nursing Home Compare scores of Florida nursing homes. The authors demonstrate a correlation: For every six-minute increase in CNA hours per resident day, a nursing home sees a 3 percent reduction in its care-quality deficiency score. The authors therefore conclude that nursing home providers would benefit by hiring more CNA staff. The study was published on the website of the Gerontologist in May 2011.

PHI’s National Clearinghouse on the Direct Care Workforce is a national online library for people in search of solutions to the direct-care staffing crisis in long-term care. It houses over 1,000 articles, reports, issue briefs, and fact sheets on the direct-care workforce.

– by Matthew Ozga

The newest additions to PHI’s National Clearinghouse on the Direct Care Workforce:

Attracting and Retaining Talent: Frontline Workers in Long-Term Care — This March 2011 report explains the Jobs to Careers program, a model of in-service trainings designed to advance the skills of direct-care workers. The program has been implemented in Hartford, Connecticut, and Portland, Oregon. The report presents a list of next steps and recommended goals to improve state and federal policies relating to direct-care worker training. Jobs to Careers is managed by the national nonprofit Jobs for the Future.

The Ties that Bind: Consistent Assignment Gives Residents a Sense of Security, Family — This article, published in the June 2011 issue of Provider, examines the use of consistent assignment in long-term care facilities. It explains why consistent assignment benefits residents, caregivers, and supervisors. The article further suggests ways to most effectively implement consistent assignment in a nursing home or other facility.

House Republican Budget Plan: State-by-State Impact of Changes in Medicaid Financing — This fact sheet examines the likely consequences of a Republican-led proposal to convert Medicaid into a block grant and repeal the Patient Protection and Affordable Care Act. The authors predict that the Republicans’ plan would lower federal Medicaid spending by 34 percent — a reduction of $1.4 trillion — between 2012 and 2021. Nursing homes would be enormously affected by the cuts, the authors note, since Medicaid accounts for more than 40 percent of the country’s nursing home spending. The fact sheet was published by the Kaiser Commission on Medicaid and the Uninsured.

Implementing Transformational Leadership in Long-Term Care — This article explains the concept of “transformational leadership” (TL), an approach to management that emphasizes the importance of treating workers as individuals: considering their needs, stimulating them intellectually, motivating them by using positive feedback, and acting as an aspirational role model to promote desired behavior. The authors posit that TL would help to reduce turnover, improve quality of care, and increase job satisfaction when applied to long-term care settings. The article appeared in the May/June 2011 issue of Geriatric Nursing.

PHI’s National Clearinghouse on the Direct Care Workforce is a national online library for people in search of solutions to the direct-care staffing crisis in long-term care. It houses over 1,000 articles, reports, issue briefs, and fact sheets on the direct-care workforce.

– by Matthew Ozga

The newest additions to PHI’s National Clearinghouse on the Direct Care Workforce:

Economic Contribution of Nursing Facilities — This February 2011 brief from the Alliance for Quality Nursing Home Care explains the economic significance of nursing facilities in the U.S. For example, the brief notes that $138 billion was spent on nursing facility care in 2008 alone. The brief also explains the negative impact that the economic recession has had on nursing facilities. Specifically, nursing facilities have had to grapple with a tightened credit market as well as cuts to or freezes on Medicaid payment rates.

Generations, Winter 2010-11 issue — This issue of Generations contains multiple articles that are pertinent to the direct-care workforce, including articles authored or co-authored by PHI experts.

In “Caregivers on the Front Line: Building a Better Direct-Care Workforce,” PHI National Policy Research Director Dorie Seavey gives a general overview of the workforce. Meanwhile, in “Federal and State Policy Strategies for Developing a Quality Eldercare Workforce,” members and staff of the Eldercare Workforce Alliance — including PHI President Steven Dawson — explain how the Affordable Care Act will benefit the eldercare workforce.

Other articles from the issue include:

• The Changing Face of Long-Term Care and How a New Immigrant Workforce Will Shape Its Future — This article explains the important role that immigrants and ethnic and racial minorities play in the direct-care workforce. The author examines several pressing issues facing the long-term services sector as the U.S. minority population expands over the next several decades, including the potential exploitation of immigrant direct-care workers.
• A Vision for the Future: New Care Delivery Models Can Play a Vital Role in Building Tomorrow’s Eldercare Workforce — This article details the increasingly important role that direct-care workers will play in the nation’s long-term care services and supports sector following the implementation of health reform provisions such as the CLASS Act. The article also provides a brief overview of the direct-care workforce. The authors are deputy assistant secretaries at the Department of Health and Human Services (HHS).
• Reinventing Management Practices in Long-Term Care: How Cultural Evolution Can Affect Workforce Recruitment and Retention — This article analyzes the extent to which the Better Jobs Better Care initiative succeeded in introducing elements of culture change into the management practices of long-term care providers. The authors write that incremental culture change — making gradual, visible changes to a long-term care facility — can be better at fostering sustainable culture change than a more radical, wholesale approach. As a result of these visible changes, workers feel more valued, and are more likely to stay.

PHI’s National Clearinghouse on the Direct Care Workforce is a national online library for people in search of solutions to the direct-care staffing crisis in long-term care. It houses over 1,000 articles, reports, issue briefs, and fact sheets on the direct-care workforce.

– by Matthew Ozga

The newest additions to PHI’s National Clearinghouse on the Direct Care Workforce:

Implementing the Coverage Provisions of Health Care Reform: What’s at Stake for Direct Care Workers — This January 2011 policy paper outlines the provisions of national health care reform that will prove to be most useful to direct-care workers. Some of those provisions include an expansion of Medicaid, the creation of a Pre-Existing Condition Insurance Plan, and the establishment of health exchanges where Americans can purchase insurance. The brief also lists specific policies that workers and their allies should advocate for to ensure that direct-care workers can take full advantage of health reform. The policy paper was published by the Direct Care Alliance.

Minimum Wage & Overtime Protection for All? — This December 2010 policy brief by the Direct Care Alliance traces the history of the so-called companionship exemption to the Fair Labor Standards Act, which excludes home care workers from receiving overtime pay and minimum wage protections. The paper details the defeat of a proposed Department of Labor (DOL) amendment which would have struck down the companionship exemption in 2001, as well as the 2007 Supreme Court case involving home care worker Evelyn Coke. The policy brief concludes with recommendations for policymakers and advocates.

Communication Between Nurses and Unlicensed Assistive Personnel in Nursing Homes — This study analyzes six nursing homes’ written guidelines facilitating effective communication between nurses and unlicensed assistive personnel (UAP) — a group that includes certified nursing assistants. The study found that the nursing homes provided extensive guidelines regarding UAP-to-nurse communications, but relatively few guidelines on how nurses should speak to UAP staff. The researchers write that the lack of nurse-to-UAP communications guidelines is troubling, and could diminish care quality in the facilities. The study was published in the December 2010 Journal of Gerontological Nursing.

Workplace Assaults on Nursing Assistants in US Nursing Homes: A Multilevel Analysis — This study, published in the October 2010 American Journal of Public Health, analyzes the trends in workplace assaults involving certified nursing assistants (CNAs) and aggressive nursing home residents. The researchers found that 35 percent of CNAs have reported injuries resulting from aggression by residents within their last 12 months of employment; 12 percent reported having been bitten by a resident. The study further shows that non-Hispanic black CNAs were much less likely to report assaults (23.2 percent), while CNAs between the ages of 18 and 24 were far more likely (53.8 percent). The researchers used data from the 2004 National Nursing Assistant Survey.

PHI’s National Clearinghouse on the Direct Care Workforce is a national online library for people in search of solutions to the direct-care staffing crisis in long-term care. It houses over 800 articles, reports, issue briefs, and fact sheets on the direct-care workforce.

– by Matthew Ozga

The newest additions to PHI’s National Clearinghouse on the Direct Care Workforce:

Promoting Sustainability in Frontline Home Care Aides: Understanding Factors Affecting Job Retention in the Home Care Workforce — This survey from the October 2010 Home Health Care Management & Practice aims to determine the factors that drive turnover among home care workers. The researchers hypothesize that the five primary factors are demographics (race, age, education level), wages and benefits, quality of training, working conditions, and intrinsic rewards. The survey confirms all of those factors as engines for turnover, and finds the most significant factors to be wages, intrinsic rewards, age (older workers are less likely to leave their jobs), and education level (more years of education result in higher retention).

Developing a Statewide Medication Technical Pilot Program in Nursing Homes — Published in the September 2010 Journal of Gerontological Nursing, this report describes a pilot program developed by the Arizona State Board of Nursing to determine the feasibility of training certified nursing assistants (CNAs) to administer medication in Arizona nursing homes. The authors conclude that CNAs can safely administer medications if properly trained. Sidebars detail the pilot program’s protocols and outline a clinical practice model for medication-administration training, complete with a list of competencies that medication trainers and trainees should satisfy.

End-of-Life Care in Nursing Homes: The Importance of CNA Staff Communication — This study focuses on end-of-life care in New York State nursing homes, and how communication between CNAs and other nursing home employees can support or impede such care. It concludes that facilities in which CNAs communicate better with coworkers perform better in end-of-life care processes. The study was published in the September 2010 Journal of the American Medical Directors Association.

A National Overview of the Training Received by Certified Nursing Assistants Working in U.S. Nursing Homes — This article describes a survey of more than 3,000 CNAs. Researchers asked the CNAs to give their opinions on the training they received before starting their jobs. They found that approximately one-third of CNAs felt their training did not adequately prepare them, and that those CNAs were also more likely to be dissatisfied with their jobs than CNAs who felt their training was more comprehensive. The survey appears in Gerontology & Geriatrics Education‘s July 2010 issue.

PHI’s National Clearinghouse on the Direct Care Workforce is a national online library for people in search of solutions to the direct-care staffing crisis in long-term care. It houses over 800 articles, reports, issue briefs, and fact sheets on the direct-care workforce.

– by Matthew Ozga