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Staff Stability Toolkit

Quality Partners Rhode Island has released a Staff Stability Toolkit that provides “how-to” tips and practical tools for nursing homes seeking to reverse turnover rates.

The premise of the guide is that staff stability is the key foundation to implementing other initiatives, quality improvements, or culture change.

The toolkit lays out an overall method and framework for increasing staff retention, discusses management practices that support stability, offers worksheets that allow facilities to gather and analyze data, and lays out options and advice on providing staff training. It also includes a case study that models the methods discussed in the toolkit.

Twelve Steps for Creating a Culture of Retention

Another recently released “how-to” guide, PHI’s 12 Steps for Creating a Culture of Retention (pdf), offers concrete steps and tools to guide agencies in developing recruitment, selection, and retention practices. The 12 steps that frame this workbook are based on the principle that direct-care workers must have quality jobs to provide the highest quality care for consumers: “quality care through quality jobs.” Intended for use by organizational leaders, the workbook encourages principles of participatory management.

Find more resources on retention at PHI’s National Clearinghouse on the Direct Care Workforce.

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

The final report’s executive summary
A research brief outlining the study’s findings (pdf)
The implementation manual (pdf)

Home health agencies that want to improve staff retention and client outcomes will find some unexpected results and useful lessons in a report recently posted to the US HHS/ASPE Office of Disability, Aging and Long-Term Care Policy website.

Home Health Aide (HHA) Partnering Collaborative Evaluation: Final Report (pdf) assesses the impact of an effort to truly incorporate home health aides into care teams. The initiative was implemented in 2003 by the Visiting Nurse Service of New York (VNSNY) and several of its licensed agency partners.

“It’s working because the aides feel more involved in the team, and they appreciate that,” says Daisy Diaz, supervising coordinator for Cooperative Home Care Associates (CHCA), one of the participating agencies. “They work hard, and it’s good for them to get acknowledged.”

It’s also good for the agency and its clients to get more regular and immediate input from the aides, Diaz adds. “They call us right away now to let us know about any issues with the patients. They also call the nurse.” Read the full story

Directors of nursing, human resource staff, and administrators of nursing homes can learn about how to reduce turnover at a free technical assistance webinar on September 25.

Experts including long-term care consultants Barbara Frank and David Farrell, Marguerite McLaughlin of Quality Partners of Rhode Island, and more will discuss the variables affecting recruitment and retention and describe a variety of interventions and best management practices that can improve retention. Among the presenters is Doug Motter of Homestead Village in Lancaster, Pennsylvania, who will talk about how staff has been affected by the culture change process his facility is going through, which includes implementing the coaching model of supervision.

The Staff Stability webinar is the last in a series of three webinars offered by the Advancing Excellence in America’s Nursing Homes campaign. The others focused on reducing restraints and assessing resident satisfaction.

Details and registration information (pdf)

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

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

“There is now a consistent pattern of data showing that homecare workers receiving benefits have a lower rate of attrition and, therefore, a higher rate of stability,” says the latest report from the Los Angeles County In-Home Supportive Services (IHSS) program.

Impact of Health Benefits on Retention of Homecare Workers: Analysis of the IHSS Health Benefits Program in LA County (pdf) is a follow-up to four reports from 2003-2006, which showed that offering medical benefits to the IHSS home care workers reduced turnover.

The present study, a five-year longitudinal retention analysis, echoes those findings. It also teases out more detail, comparing work patterns for workers who enrolled in the benefits program with those who did not, identifying traits that predict who will enroll, tracking changes in enrollment over time, and more.

The findings are significant because “The success of any kind of in-home supportive services depends on having an experienced and well-trained and committed workforce – you can’t have people stay out of institutions if there’s no workforce to take care of them at home,” says Joanne Holland, a senior clinical specialist at RTZ Associates Inc. “It’s such important work, but it’s not a high-paying position. And a lot of people are able to stay in the work because of these health care benefits.”

The study found that nearly half (45%) of the workers who enrolled in the plan were still in the workforce at the five-year mark, compared with only about a third (35%) of those who were eligible for benefits but had not enrolled.

“The stability of the workforce means you have better workers because they’re been doing it longer,” adds Holland. “It also makes for better relationships with consumers, so it’s a better experience for them.” RTZ Associates wrote the report.

See below or visit PHI’s Health Care for Health Care Workers blog to read comments or add your own.

Elise Nakhnikian, PHI, Senior Online Editor
enakhnikian@phinational.org