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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

A new Harvard School of Public Health (HSPH) study found that when long-term care managers are supportive of employees’ needs to balance home and work responsibilities, the employees slept longer and were less likely to have multiple risk factors for cardiovascular disease (CVD) than employees whose supervisors were less supportive.

These research findings point to the need for training in management practices, according to the study’s authors.

Direct-Care Workers at Greater Risk

The researchers also concluded that direct-care workers who reported to managers who were less supportive of their need to balance family and work duties were at greater risk for CVD than their coworkers, who held other jobs at the facility but also reported to less supportive managers.

Managers and 400 employees from four nursing homes in Massachusetts participated in the study. The employees were surveyed about their experiences with workplace policies and practices, given risk assessments for CVD, and monitored for their sleeping patterns.

During interviews, employees rated their managers as to whether they were “supportive, open, and creative about work-family needs, such as flexibility with work schedules.” Employees who gave their managers low ratings were found to have slept 29 minutes less each day and were more than twice as likely to have two or more CVD risk factors.

“When supervisors create and maintain good relationships with their direct-care worker staff and model effective communication skills, the staff feels more supported at work and more capable of doing their job,” said PHI Coaching and Organizational Development Specialist P. Afeefa Murray.

“PHI’s Coaching Approach to Supervision (pdf) has been effective in teaching supervisors the skills they need to support their staff and work with them in balancing work and home life. Many of these workers (pdf) are female low-wage workers who don’t have access to the necessary support systems needed to juggle work and family. Good staff support underpins quality care,” Murray said.

Managerial Training Recommended

The researchers recommend that if their findings are replicated, “special attention should be paid to training the managers of direct-care workers in supportive work-family policies,” according to the Harvard Gazette, which reported on the study.

“PHI’s evaluation research is showing that PHI’s coaching approach to supervision leads to greater job satisfaction and lower turnover,” said PHI Director of Evaluation Marcia Mayfield. “Organizations are putting into place specific policies that encourage and reward supportive supervision practices, and are finding such policies contribute to sustainable change.”

“In the next phase of this study we are exploring whether modifying workplace practices towards work-family issues will improve not only the health of the workers and their families but also of the workplace itself by reducing turnover,” said Lisa Berkman, the HSPH study’s lead author.

The study, entitled “Managers’ Practices Related to Work-Family Balance Predict Employee Cardiovascular Risk and Sleep Duration in Extended Care Settings,” was published in the July issue of the Journal of Occupational Health Psychology.

– by Deane Beebe

A new American Health Care Association (AHCA) paper presents more than 100 strategies that are designed to improve staff satisfaction among long-term care workers, including direct-care staff, in nursing homes. Read the full story

This is the first in a series examining how state budget cuts are affecting long-term care across America.

A $700 million cut to the Massachusetts state budget has many wondering how long-term care services will be affected.

Read the full story

PHI has released a comprehensive evaluation (pdf 604k) of its Northern New England LEADS Institute, a three-year demonstration project to improve the quality of direct-care jobs at 12 participating nursing homes and home care agencies in Vermont, New Hampshire, and Maine. The results showed decreased turnover at sites with strong implementation of coaching supervision and peer mentoring. All sites received training, technical assistance, and cross-learning opportunities.

Specific results include:

• Turnover for direct-care workers decreased from 2006 to 2007 for five of the ten sites (for which there are complete data).
• Two of the three organizations with very strong and sustainable coaching supervision and peer mentoring programs achieved reductions in both turnover and call outs.
• Five of the nine organizations with strong implementation of one or more LEADS interventions improved on turnover and/or calls outs.

Read the full story

Graduates of the PHI coaching supervision train-the-trainer program recently gathered outside Philadelphia to share their skills, ideas and experiences at a peer gathering sponsored by PHI’s Center for Coaching Supervision and Leadership (CCSL). The gathering took place Sept. 17 and 18 at the Villanova Conference Center.

Over 50 participants from as far away as Oregon and North Carolina traveled to Pennsylvania to deepen their coaching supervision skills and share lessons learned. Trainers were able to connect with others who were at various stages of implementing coaching supervision, and to participate in skill-building workshops. Read the full story