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In the July issue of the PHI Training & Organizational Development Services (TOD) newsletter, Kathy McCollett, a PHI organizational change specialist, gives new meaning to “informed consent,” using the language of culture change.

Meanwhile, Renya Larson, a specialist with PHI’s Training & Organizational Development team, discusses why teamwork matters.

Visit the PHI Training & Organizational Development Services site to read past newsletter posts and to subscribe.

– by Deane Beebe

Long-Term Living magazine has published the first in a series of monthly columns by PHI National Director of Training and Organizational Development Susan Misiorski.

The series will focus on lessons learned from PHI’s recent series of case studies and best practices highlighting exemplary employers in long-term care.

In her first column, Misiorski, a registered nurse, summarizes findings from two of PHI’s case studies:

• Orchard Cove, a retirement community located in Canton, Massachusetts, and
• The Cottages at St. Martin’s in the Pines, a nursing home in Birmingham, Alabama.

Orchard Cove was singled out by PHI because of its relationship-centered culture as well as its successful adoption of the PHI Coaching Approach to Supervision^SM. As noted in the blog post, Orchard Cove significantly improved its resident outcomes through its culture change initiative.

St. Martin’s, meanwhile, earned recognition for its use of THE GREEN HOUSE® model of eldercare, which focuses on building relationships that promote the personal development of both elders and staff. PHI officially partners with THE GREEN HOUSE Project, providing administrators, known as “Greenhouse guides,” with support in working with self-managed teams and also its expertise in curriculum development.

Both facilities prove that “investing in [direct-care] workers, with better training and career opportunities, is critical to enhancing the quality of life for residents in our nation’s nursing homes,” Misiorski writes.

PHI’s series of case studies and best practices was funded by The Hitachi Foundation.

– by Matthew Ozga

PHI has published a series of in-depth case studies and brief profiles of organizations that exemplify the goal of providing quality care through quality direct-care jobs.

The case studies tell the stories of eight long-term care organizations whose overarching management philosophies have led to better-quality jobs for their direct-care workers and better-quality care for consumers.

The 20 shorter “best practice” profiles, meanwhile, focus on specific practices employed by long-term care companies to reduce turnover, promote job satisfaction, and implement relationship-centered care — all of which have a positive effect on the care that consumers receive.

All of the employers profiled have reversed the industry’s usual strategy of low investment in, and high turnover among, direct-care workers.

Instead, by investing more in their direct-care staff, these organizations have created a low-turnover employment model, resulting in higher-quality care.

Barbara Dyer, President and CEO of the Hitachi Foundation, which funded the case studies and best-practice profiles, said:

The aging population and stagnant growth in other industries have made direct-care workers more essential than ever. And yet too many direct-care jobs are low-quality with sharply limited career options. The client-centered healthcare providers profiled by PHI demonstrate that investing in the training, compensation, and career opportunities of direct-care workers can provide considerable competitive advantages in the years to come.

The Business of Caregiving

The series of PHI case studies, entitled The Business of Caregiving, profiles eight different organizations from Los Angeles to Massachusetts.

The common thread uniting each of the organizations is that they have all implemented practices designed to attract and retain a strong direct-care workforce, resulting in positive changes for the business, the workers, and the consumers.

For example, the Visiting Nurse Association (VNA) of Indiana County, Pennsylvania, is singled out for its staff orientation and mentoring programs, its competitive wages and benefits, and the many opportunities for career advancement available to its direct-care staff.

Several of the nursing facilities that are featured have found that investing in frontline staff is essential to their efforts to implement changes such as consistent assignment, self-managed households, and individualized care.

Many of the case studies include a multimedia component, such as podcasts, photo slideshows, and charts.

Best Practices

The best-practice profiles, meanwhile, examine single practices in 20 different geographically diverse long-term care organizations.

St. Peter Villa, a long-term care facility in Memphis, for example, has had success reining in the sky-high turnover rate among its certified nursing assistants (CNAs) by introducing a career ladder. Since 1999, when implementation began, turnover is down considerably, as CNAs have a way to learn new skills, advance their careers, and earn more money without having to get a different job.

All of the PHI best-practice profiles and case studies are published at the PHI Training & Organizational Development Services website.

– by Matthew Ozga

“Improving Jobs and Care: a National Sector Strategy,” a new paper by PHI President Steven Dawson, provides an overview of PHI’s work at the intersection of low-wage workforce development and eldercare and disability services.

The paper offers an in-depth look at PHI’s:

• history;
• systemic change strategies for the eldercare/disabilities services system;
• sectorial employment initiatives — the framework for PHI’s field-building strategy; and
• lessons learned along the way.

Dawson shares five lessons learned over the two decades that have shaped PHI’s core organizational strategies and tactics:

• Positioning: To influence an entire sector, the workforce practitioner must establish and maintain a careful organizational balance of being in relationship with each of the key stakeholders — offering real value to each — yet being perceived as “in the pocket” of none.
• Asset-Based Fundraising: Workforce leaders should design their initiatives from the outset with the intention of converting grant funds into assets. Current funding must simultaneously achieve the promised program impact and create something of future value.
• Building Ladders and Raising the Floor: The workforce development community must insist on policies and strategies that focus equally on both “building ladders” and “raising the floor” for the millions of low-wage jobs in the U.S. economy, confronting the existing bias toward creating ladders to “escape” poor quality jobs.
• Expertise, with an Attitude: Despite others’ expectations that an organization be either a research shop or an advocate, PHI continues to both undertake its own rigorous evaluation of work in the field and to become the most informed organization in the country, so that its expertise cannot be ignored. PHI believes that “expertise, with a point of view” is not only possible, but essential, in creating fundamental change.
• “Going to Scale” Reconsidered: In the current economy, the resources of the philanthropic community are relatively constrained, so its earlier calls to “go to scale” can no longer be backed quite so boldly with commensurate amounts of funding. Dawson suggests that perhaps an “enclave” strategy, in which philanthropy deepens and protects high-quality programs, is more appropriate during these troubled times.

Prevailing Business Model Will Not Meet Demand

Regarding the eldercare/disability service delivery system, Dawson writes that “the prevailing ‘business model’ — low investment in staff, leading to high turnover, leading to low quality of care — wastes precious resources, both capital and human.” He states that such a model will not be able to meet the ever increasing demand of elders and people with disabilities.

Instead, over the years, PHI has promoted an inverted version of the current model:

High Investment –> Low Turnover –> High Quality/Efficiency

The organization has branded its positive vision of relationship-centered care as “Quality Care through Quality Jobs,” defining the essential elements of both.

A Presumptuous Venture

Detailing the many stakeholders in low-wage workforce development and eldercare and disability services, Dawson notes the complexity of the territory in which PHI works. He describes the efforts of PHI to:

• provide real improvement in the lives of its constituents — direct-care workers, elders, and people with disabilities — that they want and deserve;
• offer practical expertise to its clients; and
• create the systematic change its funders seek.

Despite the complex terrain, Dawson writes that “For more than 25 years, the leaders associated with PHI and its affiliates worked to achieve all three — directly impacting thousands of lives and creating practical value for key stakeholders, while also changing the surrounding systems for the better. Admittedly, a presumptuous venture from the start.”

PHI Roots and Affiliations

PHI grew out of the Bronx-based Cooperative Home Care Associates (CHCA) 20 years ago. Initially CHCA’s nonprofit training arm, PHI continues to be affiliated with the agency though its mission as a national sectoral initiative has broadened substantially.

PHI is also affiliated with Home Care Associates of Philadelphia, a replication of the CHCA model that PHI worked to develop, and Independence Care System, a New York City Medicaid-funded managed long-term care program for adults with physical disabilities that PHI helped to create.

“Improving Jobs and Care, a National Sector Strategy” was made possible with support from the Hitachi Foundation.

The paper was released on May 26 at the “Building Ladders and Raising the Floor” meeting, which was organized by Jobs for the Future and PHI.

– by Deane Beebe

Benchmark Senior Living

A New England-based company that manages dozens of senior living communities and an Alabama long-term care facility are profiled in the latest case studies in PHI’s The Business of Caregiving series.

Benchmark Senior Living, headquartered in Wellesley, Massachusetts, provides its workers with plentiful career advancement opportunities, designed to maintain a high retention rate.

Benchmark also operates a unique “Culture Compensation” program, in which employees are monetarily rewarded for demonstrating values consistent with the Benchmark mission of providing quality care for residents.

The Birmingham-based St. Martin’s in the Pines, meanwhile, adopted The Green House model to better care for its nursing home residents.

St. Martin's in the Pines

The Green House model calls for a wholesale physical and philosophical reorganization of traditional nursing home-based care.

Under the Green House model, for example, direct-care workers — known as “Shahbazim” — provide a range of services, including personal care, meal planning, and laundry service for residents.

In turn, Shahbazim are empowered by being given additional responsibilities, including self-scheduling each day with their resident, and participating in self-managed work teams to manage the facility.

All Shahbazim are required to undergo a 120-hour training before working in a Green House facility.

Both Benchmark and St. Martin’s were selected to be subjects of PHI case studies because they exemplify PHI’s “quality care through quality jobs” approach to eldercare/disability services.

Four other Business of Caregiving case studies are available at the PHI Training & Organizational Development Services website.

The case studies, as well as a series of 20 best practice profiles, were made possible with support from the Hitachi Foundation.

– by Matthew Ozga

In light of proposals by Congressional Republicans to slash Medicaid funding, PHI is publishing a series of fact sheets outlining the crucial role Medicaid plays in the lives of direct-care workers and the families they care for.

The first installment of the PHI “Medicaid Matters” series focuses on Medicaid’s impact on long-term services and supports, while the second concentrates on Americans’ reactions to the proposed Medicaid cuts.

Both fact sheets address recent Congressional proposals to convert Medicaid to a block grant, which would shift the burden of paying for much of Medicaid’s costs to states, whose funds have already been decimated by the economic downturn.

Impact on Long-Term Services and Supports

The fact sheet Medicaid Matters…for Long-Term Services and Supports notes that:

• Medicaid is the largest payer of long-term services and supports for elders and people with disabilities.
• Medicaid provides health coverage to direct-care workers and their families.
• Medicaid funds millions of direct-care jobs and fuels our nation’s economy.
• Turning Medicaid into a block grant hurts America’s families.

What Medicaid Means to Americans

Medicaid Matters…to the American People, the second installment of the Medicaid Matters fact sheet series, cites several public-opinion polls indicating that Americans emphatically do not want Medicaid to be cut:

• A Kaiser Family Foundation poll from April found that just 12 percent of Americans support big cuts to Medicaid.
• A March Washington Post/ABC News poll showed that 76 percent of respondents opposed the idea of cutting state Medicaid funds to balance their state’s budget.
• Respondents to a Quinnipiac University poll released earlier this month were told that Medicaid, Medicare, Social Security and defense spending accounted for 60 percent of the federal budget — yet a majority of respondents (57 percent) still opposed any cuts to Medicaid.

Indeed, polling data continue to show Americans’ opposition to Medicaid cuts: A Kaiser Family Foundation poll released May 25 found that a majority of Americans want to keep Medicaid exactly as it is, and not make it a block grant.

– by Matthew Ozga