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The July issue of The Gerontologist is devoted to findings from the Better Jobs Better Care research and demonstration project. BJBC, which began in 2002 and ended in 2006, was the largest initiative in the nation ever created to address the high vacancy and turnover rates of direct-care workers by improving the quality of direct-care jobs. The initiative involved changing both public policy and employer practice. Demonstration grants were made to groups in Iowa, North Carolina, Oregon, Pennsylvania, and Vermont.

A nine-page overview lays out how and why the project came into being, the problems affecting the direct-care workforce, and how awareness of and responsiveness to those problems is changing. The essay is by Robyn Stone (pictured), executive director of the Institute for the Future of Aging Services, and PHI President Steven Dawson. FAS and PHI conceived of BJBC and provided technical assistance to the grantees. Funding was supplied by the Robert Wood Johnson Foundation and The Atlantic Philanthropies.

Among the findings detailed in the issue:

• Direct-care workers across long-term settings identified more pay, improved communication, better supervision, and being treated with respect as the most important things employers could do to improve jobs.
• After accounting for satisfaction with wages, benefits, and advancement opportunities — good basic supervision was most important in affecting CNAs to stay in their jobs.
• There is a positive correlation between CNA job commitment and resident satisfaction.
• After accounting for satisfaction with wages, benefits, and advancement opportunities, good basic supervision was the most important factor behind commitment to the job. Read the full story

The nursing home regulatory system sets unrealistically high standards of care because “there has been no analysis of the resources – and particularly the labor resources – necessary to achieve these standards,” said John Schnelle (pictured) of Vanderbilt University at a July 11 Capitol Hill briefing on long-term care reform. “Some studies suggest that twice the number of aides as are currently present in most homes would be needed to meet current standards of care.”

The briefing, which was co-hosted by The New School and the Brookings Institution, focused on ways of improving care quality and addressing the challenges of financing long-term care. More than a dozen panelists – including senators, other policy experts, academics, advocates and providers – discussed policy and political options.

Schnelle called for either setting more realistic care standards or increasing the amount of money we pay for long-term care. “I would prefer the latter,” he said, adding that either would be an improvement.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

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.”

Read the full story

“If I had only one sentence, this would be it: Direct support work is a highly skilled job,” says Amy Hewitt.

“It’s not viewed that way by society – or, frankly, by many employers – but not everybody can do this job. You have to be smart; you have to be able to problem solve; you have to be flexible and a quick thinker. You also need patience and empathy and creativity. We’re not going to get anywhere in terms of policy advocacy or getting the supports we need in place without clearly articulating that this is a highly skilled job.”

Hewitt is a senior research associate at the University of Minnesota’s Research and Training Center on Community Living. The center’s mission is to support community living for people with intellectual and developmental disabilities – and that has led to a focus on strengthening and supporting the direct support workforce.

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Update: Jane Gross emailed me on the Fourth of July to enthusiastically invite “your readers — direct care workers, supervisors or anyone else” to contribute to her blog. This is a great opportunity to talk to long-term care consumers and family members about the challenges and rewards and importance of direct-care work. Maybe we can raise a little consciousness, even recruit some valuable allies for the quality care through quality jobs movement. — Elise

A new blog by New York Times health writer Jane Gross (pictured) provides a fascinating window into the world of family caregivers, including their thoughts about direct-care workers.

Gross started the blog after she helped her own mother find care and became a magnet for questions from colleagues at the paper who were in the same position. They all felt as overwhelmed as she had when she first encountered the long-term care system, like sailors trying to navigate the ocean in a rudderless boat (okay, so that’s my metaphor, not hers, but you get the idea.)

Having essentially the same conversation over and over made Gross realize how many people share the same questions and concerns, so she started the blog to provide “a source of information and community for grown children faced with these new responsibilities, for the elderly adjusting to unwelcome limitations and dependency, [for] employers interested in easing the burden, for professionals in the field and for anyone else who wants to chime in.”

Read the full story

“There’s really no mystery here,” says PHI President Steven Dawson in an interview about solving the staffing problem in long-term care. “It’s a matter of providing a living wage, healthcare coverage, support, and recognition of what these workers do and providing the training they need to do the job well. It’s a matter of political will.”

“The fundamental problem has to do with the industry’s current basic business model of low-investment, high-turnover,” Dawson adds. “It’s based on the assumption that there’s a virtually endless supply of these workers, but I believe that the era of an endless supply of labor is coming to an end…. The approach to dealing with this new era will instead have to be “high-investment” on several fronts.”

The interview was conducted by Richard Peck, editor of Long-Term Living magazine, for the magazine’s website.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org