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“Nursing administrators who want to promote staff-supportive culture in their facilities should recognize the key role of staff resources,” concludes a study in Journal of Gerontological Nursing, Vol. 34 No. 3. “Efforts to ensure adequate staff resources (in terms of number and mix of staff) might be most effective in facilitating staff-supportive organizational culture.”

“Predictors of Staff-Supportive Organizational Culture in Assisted Living“ (free to subscribers only) is based on a study of 294 staff members in 52 Maryland assisted living facilities.  Most of the workers were nursing assistants. The survey measured employees’ perceptions of teamwork, morale, information flow, involvement, supervision, and quality of meetings.

Staff in facilities licensed to provide higher levels of care rated their organizational culture as significantly more supportive than their peers in facilities providing lower levels of care – maybe because they are generally better staffed, hypothesizes author Elzbieta Sikorska-Simmons.

The second strongest predictor of staff-supportive organizational culture was a facility’s size, with smaller facilities ranked higher. Staff in small facilities were more demographically homogeneous and less structurally segregated (e.g., African-American employees were more likely to occupy professional positions), which leads to more cooperation and a more socially cohesive work environment.

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Nursing homes not only can but must change the way they operate, becoming better places to live and work. Only then will they be able to reduce the epidemic of violence that currently plagues them, according to an article in the Journal of Gerontological Nursing, Vol. 34 No. 3.

CNAs often experience “harassment, threats, and assaults” from residents, and the number of those incidents is probably “seriously underestimated,” according to “Policy Recommendations on the Prevention of Violence in Long-Term Care Facilities.” (The article is free to subscribers only; others must pay.)

Those attacks cause emotional distress, which can lead to more confrontations. “Frustrated and fearful, CNAs’ voices might be louder and their movements rougher, causing residents to respond in an aggressive manner,” notes the report. A vicious cycle of abuse can also occur when, “in retaliation, such aggressive behavior results in staff-to-resident abuse.”

Low reimbursement levels lead to low staffing levels at most nursing homes, which is a major contributing factor, the report says. “CNAs are more apt to deliver care in a rushed, rough, and hurried manner when assigned a large number of residents. A hurried approach is likely to cause residents to become more aggressive, thus increasing the risk of assault.”

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Nursing staff levels and other measures will soon be translated into a five-star rating system for nursing homes by the Centers for Medicare and Medicaid Services, although it is not yet clear how the data will be translated into ratings. CMS is soliciting input into the process during June and July.

In a June 18 press release, CMS called the planned system “ground-breaking,” noting that this is the first time it has ever offered a rating system for any Medicare-funded providers. The agency says the ratings are intended to help residents and their families make “meaningful distinctions between high performing and low performing homes.” The ratings will be posted on the agency’s Nursing Home Compare Web site by the end of this year.

The only nursing staff measure currently on Nursing Home Compare is the number of hours per resident per day. CMS comes up with that estimate by using self-reported data from the homes, calculating the total number of nursing staff per resident day as well as RN, LPN/LVN, and CNA hours per resident day.

But it’s hard to know what to make of those figures with no information about the special needs and acuity levels of each home’s residents – and no way to check on the accuracy of the data to begin with. What’s more, there are no federal minimum nursing staff levels to compare the results to, although some states have their own staffing requirements.

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“According to the Department of Labor, direct care is the fourth-fastest-growing job category in the nation but is noted as one of the ‘10 worst jobs in America,’ next to those who clean portable restrooms,” says Judith B. Clinco in an editorial in the Arizona Daily Star. “Most direct-care workers receive inadequate training, inadequate wages, minimal or no benefits, no health-care coverage and face unrealistic job demands. These compassionate, caring workers are simply not honored or valued or respected.”

Neither consumers or employers can afford to pay what workers deserve, says Clinco. “The solution is for the federal government to subsidize wages and benefits for this work force so that regardless of age, illness or economic status, everyone who needs long-term care will have it. A starting wage of $15 per hour is not excessive.”

Clinco is the founder of the Direct CareGiver Association, a Tucson, Arizona-based nonprofit that provides education and support for direct-care workers.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

“My passion for working with people with dementia, for making life better for them, has been my major motivating factor. But over time, I keep saying to myself: ‘It’s the direct-care worker, stupid,’” says Joanne Rader. “The only way to make the lives of people with dementia better is to improve the working lives of the direct-care workers. We need to put the things in place that let them provide relationship-based care.”

Now a consultant, Rader has helped pioneer key advances in reducing the use of restraints and finding conflict-free ways of bathing in long-term care. The co-author of Individualized Dementia Care: Creative, Compassionate Approaches and Bathing Without a Battle, which won Book of the Year awards from the American Journal of Nursing in 1996 and 2002, she is one of the founders of the Pioneer Network.

She learned to appreciate the contributions made by direct-care workers early in her career. “I’ve always had a tremendous amount of respect for the work they do, and also for the informal power they have. I might have had the best solution in the world, but if I didn’t have their buy-in, it wasn’t going to get anywhere.” Read the full story

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Martha Stewart segued from living to assisted living today at a U.S. Senate Special Committee on Aging hearing today, talking about her experiences as a caregiver for her mother.

The hearing explored the growing shortage of geriatric care workers and the need to better support family caregivers, which was the subject of an Institute of Medicine report released two days ago.

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