PHInational.org

“The residents come to know you better and trust you,” says a CNA of the changes a nursing home experienced after implementing consistent assignment.

The new system also benefits the home’s direct-care workers, according to a one-page report (pdf) by the Iowa Foundation for Medical Care, the Medicare Quality Improvement Organization for Iowa. “The staff have ownership and they are loving it,” says Assistant Administrator Deb Pascoe. Staff chose the neighborhoods they wanted to work in and divided resident caseloads.

The report describes an initiative by Wyndcrest Nursing Home in Clinton, Iowa, which piloted the change on one shift for several months before introducing it on others. “It’s important to remember that change takes time,” Pascoe explains. “Pilot testing provided us with an opportunity to work through problems before implementing it facility-wide.”

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

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.”

Read the full story

“Higher wages, training and benefits would make being a direct support worker a respected profession and a viable career choice,” notes Kathleen Bates in The True Costs and Benefits of Self-Directed Care: Living with Independence, Freedom, and Equality (LIFE) Account Feasibility Study & Implementation Plan. (pdf)

Bates describes her own circumstances and those of several other New Hampshire residents in order to outline the challenges of living with a disability and finding competent and compatible direct-care workers to help with daily activities - not to mention backup when a caregiver is unable to get to work. She also describes the rewards of managing one’s own care and maintaining one’s role as a parent, a worker, and a fully engaged member of a community.

The goal of consumer-directed models like New Hampshire’s The Personal Care Attendant program, says Bates, is to improve the quality of life and increase the access to community for people with disabilities. And “in order to make this work,” she writes, ”we need to invest in the work force.”

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

Advocates for people with disabilities have made consumer-directed personal assistance services a priority, but CD-PAS are not for everyone. And a big part of the reason  is the difficulty many consumers have in finding the workers they need, according to a new report from the Kaiser Family Foundation.

“CD-PAS participants face challenges recruiting direct care workers because they lack the infrastructure and economy of scale that agencies use to recruit workers,” says Consumer Direction of Personal Assistance Services in Medicaid: A review of four state programs. Authors Henry Claypool and Molly O’Malley also note that it is often difficult for consumers to arrange back-up service on short notice when needed.

“As CD-PAS programs grow, states and beneficiaries will face challenges in maintaining a steady work force of care workers for these programs and enhancing the programs’ quality and support structure,” they write. Before starting or augmenting a Medicaid-funded CD-PAS program, they recommend that states study and understand “the issues that affect direct care workers, such as wages and benefits.”

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org