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Sen. Robert Casey (D-PA)

Senator Robert Casey (D-PA) has introduced a bill that would expand the role of direct-care workers across the country.

The Improving Care for Vulnerable Older Citizens through Workforce Advancement Act (pdf) would establish demonstration projects focusing on care coordination and service delivery redesign for older adults with chronic illnesses, or those at risk of institutional placement.

“Direct-care workers are key to providing services that improve the health of older Americans and reduce re-hospitalizations, vastly improving the quality of life for our older citizens and reducing costs and strain on the entire healthcare industry,” Casey said.

“My legislation will help to better train and utilize direct-care workers to lower the cost and improve the quality of healthcare provided to older Americans,” he continued.

Demonstration Projects Detailed

The bill would create six three-year demonstration projects:

• Two would incorporate direct-care workers into interdisciplinary care coordination teams to promote smooth care transitions and prevent unnecessary re-hospitalizations;
• Two would have direct-care workers take on a greater role in monitoring, maintaining, and improving their consumers’ health status; and
• Two would train direct-care workers to care for specific diseases and afflictions, including dementia, diabetes, and congestive heart failure.

“With adequate training, compensation, and support, a newly created ‘advanced aide’ position could support health promotion, better chronic care management, and care transitions, resulting in less institutionalization and fewer re-hospitalizations,” PHI President Steven Dawson said.

Partnerships of health service providers, including at least one long-term care facility or home and personal care service provider, are encouraged to apply for demonstration funding if the bill passes into law.

PHI has published a one-page backgrounder (pdf) capturing the highlights of Casey’s bill.

– by Matthew Ozga

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 PHI Center for Coaching Supervision and Leadership (CCSL) produced numerous positive, tangible outcomes for employers, according to a just-released PHI evaluation summary of the program.

Participants in the CCSL, for example, reported improvements in quality of care as well as statistically significant gains in job satisfaction among all staff.

The four-year CCSL program was designed to refine the PHI Coaching Approach to Supervision, a training program that teaches long-term care supervisors the core communication skills necessary to effectively engage and support their teams.

Eleven providers in the Northeast U.S., including five nursing homes and six home health agencies, were involved in the CCSL initiative.

Specific Findings

PHI’s evaluation of the CCSL program found that:

• Trained supervisors retain the lessons of PHI Coaching Supervision^SM. One year after their training, more than three-fourths (77 percent) of supervisors involved in CCSL said they “often” or “always” used the communication skills they were taught.
• Job satisfaction increased. Direct-care workers surveyed showed significant improvements in job satisfaction following the CCSL intervention.
• Some employers experienced efficiencies. Three out of 10 supervisors and managers reported spending less time solving other people’s problems. All told, 25 supervisors reported a total of 75 hours saved per week, or nearly four weeks each year for each supervisor.
• Certain participants reported increased care quality. For example, one of the CCSL participants — Orchard Cove, a continuing care retirement community in Massachusetts — recorded downward trends in fall prevalence, urinary tract infections, pressure ulcers, and other quality indicators.
• Providers invested in sustainability. Evaluation respondents expressed their interest in sustaining the positive outcomes they gained from PHI Coaching Supervision training. To that end, they have instituted numerous strategies — including booster sessions and the use of cross-functional teams — intended to “keep coaching alive.”

CCSL was funded by the John A. Hartford Foundation and The Atlantic Philanthropies.

More information about the PHI Coaching Approach is available at the PHI Training & Organizational Development Services website.

More information about the evaluation of PHI initiatives and services is available at the PHI Evaluation page.

– by Matthew Ozga

DOL Secretary Hilda Solis

Seven hundred home care workers; domestic workers; community and faith-based leaders; union representatives; government officials; workforce, aging, and social justice advocates; and consumers of home care services and supports convened in Washington, DC, on July 12 for the inaugural Care Congress, a national town hall meeting on caregiving in America.

A broad coalition of 70 partners, including PHI, came together to begin a national dialogue rooted in values to transform long-term care for older adults and people living with disabilities, paid caregivers, and families.

“Quality care, quality jobs” was echoed throughout the day, which was the kickoff of Caring Across Generations: Changing the Way We Care, a national campaign being spearheaded by the National Domestic Workers Alliance and Jobs with Justice.

As part of the campaign, local Care Congresses are planned for at least 15 cities over the next year.

“Many of our members who began as housekeepers or nannies began asking for training in caring for the aging because their employers were increasingly calling on them to do that work,” said Ai-jen Poo, director of the National Domestic Workers Alliance.

“We realized that domestic workers were helping to fill a gap in care facing hundreds of thousands of families,” she said.

Federal Policy Solution

With the demand for home care growing as baby boomers began turning 65 this year, the coalition is promoting a federal policy solution with five interdependent components — represented by the “Five Fingers of the Caring Hand”:

• Create jobs to meet the growing need for care; explore creative, new funding streams for job creation.
• Transform the quality of current jobs and anticipated jobs by
  • establishing stronger labor standards that protect the health and safety of both workers and consumers;
  • improving job quality, wages, and access to health insurance; and
  • supporting the right to organize and a path to unionization for direct-care workers and domestic workers.
• Provide training and build career ladders to raise the quality of care and prepare workers for quality long-term care jobs; develop certification programs.
• Provide a path to citizenship for immigrant workers who complete training and certification programs to provide care to elders and people with disabilities.
• Support individuals and families by
  • preserving Medicaid, Medicare, Social Security, and the Affordable Care Act;
  • ensuring that improving job quality does not jeopardize access to care for people with low incomes by providing concurrent financial support for families paying out of pocket; and
  • supporting unpaid family caregivers who are taking time from employment with Social Security credits and paid family leave.

Secretary Solis Welcomes FLSA Input

Sen. Al Franken (D-MN)

In her opening remarks at the Care Congress, Department of Labor (DOL) Secretary Hilda Solis told the participants that she welcomed their input on DOL policies — specifically noting the “companionship exemption” in the Fair Labor Standards Act. (Postcards were on hand to write to the Secretary to issue new rules to “narrow the companionship exemption.”)

Solis said that her own mother was a caregiver who “left her family to care for others” — the “hardest work to do.” She explained that her father was a shop steward and that she supported unions so that “voices can be heard” and “people could live better lives.”

Solis also expressed her deep concern about the current state efforts to roll back collective bargaining rights for public employees.

Medicaid Matters Across Generations

About 300 of the Care Congress participants headed over to Capitol Hill for a forum entitled “Medicaid Matters Across Generations,” co-hosted by Senator Jay Rockefeller (D-WV).

White House Senior Advisor Valerie Jarrett

People provided moving testimony about how Medicaid has made it possible for them or a loved one to access desperately needed health care — from home and community-based care to nursing home care.

Senators Al Franken (D-MN), Sheldon Whitehouse (D-RI), and Claire McCaskill (D-MO) expressed their support for the Medicaid program at the event.

Referencing the budget talks and Republican Congress members’ stand on not raising taxes, Whitehouse said, “A deficit doesn’t care if a dollar comes from tax cuts or revenue.”

Earlier in the day, Valerie Jarrett, a senior advisor and assistant to President Obama, told the Care Congress participants that the President understands that Medicare and Medicaid are more than numbers — they are “about people.”

– by Deane Beebe

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