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The newest additions to PHI’s National Clearinghouse on the Direct Care Workforce:

Attracting and Retaining Talent: Frontline Workers in Long-Term Care — This March 2011 report explains the Jobs to Careers program, a model of in-service trainings designed to advance the skills of direct-care workers. The program has been implemented in Hartford, Connecticut, and Portland, Oregon. The report presents a list of next steps and recommended goals to improve state and federal policies relating to direct-care worker training. Jobs to Careers is managed by the national nonprofit Jobs for the Future.

The Ties that Bind: Consistent Assignment Gives Residents a Sense of Security, Family — This article, published in the June 2011 issue of Provider, examines the use of consistent assignment in long-term care facilities. It explains why consistent assignment benefits residents, caregivers, and supervisors. The article further suggests ways to most effectively implement consistent assignment in a nursing home or other facility.

House Republican Budget Plan: State-by-State Impact of Changes in Medicaid Financing — This fact sheet examines the likely consequences of a Republican-led proposal to convert Medicaid into a block grant and repeal the Patient Protection and Affordable Care Act. The authors predict that the Republicans’ plan would lower federal Medicaid spending by 34 percent — a reduction of $1.4 trillion — between 2012 and 2021. Nursing homes would be enormously affected by the cuts, the authors note, since Medicaid accounts for more than 40 percent of the country’s nursing home spending. The fact sheet was published by the Kaiser Commission on Medicaid and the Uninsured.

Implementing Transformational Leadership in Long-Term Care — This article explains the concept of “transformational leadership” (TL), an approach to management that emphasizes the importance of treating workers as individuals: considering their needs, stimulating them intellectually, motivating them by using positive feedback, and acting as an aspirational role model to promote desired behavior. The authors posit that TL would help to reduce turnover, improve quality of care, and increase job satisfaction when applied to long-term care settings. The article appeared in the May/June 2011 issue of Geriatric Nursing.

PHI’s 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

Enhancing the Employability and Well-Being of Low-Income Older Americans

The Urban Institute is sponsoring a forum in Washington, DC, entitled “Enhancing the Employability and Well-Being of Low-Income Older Americans,” on June 29 from 9-11am EST.

The event can be viewed live via webcast and will also be archived online.

With unemployment of older adults at its highest rate in 30 years, the forum will examine how cross-system partnerships, policies, and practices can improve low-income older Americans’ employment, civic engagement, well-being, and self-sufficiency.

Joe Angelelli, PHI Pennsylvania state director, will join panelists in a discussion on examples of collaborative efforts to increase the employability and well-being of older adults with low incomes.

Angelelli will report on a PHI analysis of the direct-care workforce that found that women age 55 and older are projected to become 30 percent of the nation’s direct-care workforce by 2018 — up from 22 percent in just 10 years. In 2010, nearly 30 percent of personal and home care aides were women age 55 and older.

He will also discuss his experiences providing relationship-centered direct-care training, and how such care improves jobs for direct-care workers of all ages.

More information about the forum, panelists, and discussants is available at the Urban Institute website.

Registration is required to attend the Washington, DC, forum. No registration is required to view the webcast.

Reduce Staff Turnover and Boost Employee Morale

The California Local Area Network for Excellence (LANE) is sponsoring a webinar and telephone conference entitled “Reduce Staff Turnover and Boost Employee Morale,” on June 30 from 2-3:15 pm PST.

The program is targeted to nursing home owners, administrators, nursing staff, certified nurse assistants, staff developers, and other nursing home personnel.

The objectives of the webinar are to:

• Learn practical ways to boost employee morale and reduce absenteeism and turnover.
• Hear how consistent assignment improves care and resident and staff satisfaction.
• Learn how to implement consistent assignment and track your effectiveness.
• Identify ways the Advancing Excellence in America’s Nursing Homes campaign can assist in reducing turnover and implementing consistent assignment.

Registration is required and is free to members of the Advancing Excellence in America’s Nursing Homes campaign.

More information on the program, including the availability of CEUs, is available online.

– by Deane Beebe

Jed A. Levine

A guest column by Jed A. Levine, executive vice president and director of programs and services at the Alzheimer’s Association, New York City Chapter.

Alzheimer’s disease (AD) is the public health crisis of the 21st century. An estimated 5.4 million people have AD in the United States, and that number is projected to increase to 13 million by mid-century unless we find a way to prevent, delay, or cure the disease.

We spend $183 billion annually caring for persons with AD.

The disease affects not only an individual’s memory, but all areas of thinking, function, and behavior. Persons with AD become progressively dependent on others for all their activities of daily living (ADLs). There is no cure, and only modest treatment for the symptoms of the disease. The disease can last up to 20 years, with a mean of 8-10 years.

For many families, home care workers are a lifeline. With the help of these workers, family members who would otherwise need to provide full-time care can continue working and providing for spouses and children.

For persons with dementia, quality of life depends on quality of care and their relationships with their care providers. In the early and middle states of the disease, persons with dementia can still experience pleasure and meaning in their lives. The quality of the assistance and support they receive is critical. Even when the disease is advanced, the person with dementia can experience comfort and does not have to suffer.

Valuable, Practical, and Proven

Dementia care is hard work; it takes specialized skills that can be learned by caregivers.

Since 1989, the Alzheimer’s Association, New York City Chapter (AANYC), has provided in-depth training on dementia care for home care workers, through agencies and for individuals.

This 50-hour training builds skills such as:

• communication;
• understanding and responding to “behavioral symptoms”;
• engaging the person with dementia;
• understanding the family’s experience; and
• self-care, such as meditation and yoga.

A recent formal evaluation of the 50-hour dementia care training showed that the person with dementia showed greater improvement in behavior and emotion when cared for by a trained aide. The person with dementia was also found to be “communicating more,” “less agitated,” and “more cooperative with ADLs.”

Family caregivers also rated trained aides positively, including overall satisfaction with the aide.

The study also found that trained aides were more likely than their non-trained counterparts to stay in the field of dementia home care.

As the population of persons with dementia, including AD, grows, so too will the demand for trained home care workers. AANYC has developed a model of training that is valuable, practical, and proven.

More Information

To learn more about the training evaluation, contact Edward Cisek, Ph.D., AANYC.

To inquire about the dementia training, contact Matt Kudish, LMSW, AANYC.

For more information about AANYC, or any of the 78 local chapters, visit the website, or call the national 24-Hour Helpline at 1.800.272.3900.

Some information in this article was taken or adapted from the following publications published by the Alzheimer’s Association:

• 2011 Alzheimer’s Disease Facts and Figures (pdf)
• The Shriver Report
• Alzheimer’s Association Quality Care Guide, Dementia Care Practice Recommendations for Professionals Working in a Home Setting (pdf)

A new report from the Long Term Care Community Coalition (LTCCC) examines the current state of the quality of care and life in New York’s assisted living facilities, as well as the ability of the state Department of Health (DOH) to oversee this system.

The May 2011 report, Care and Oversight of Assisted Living in New York State, analyzed DOH survey data from 2002 to 2011 and ombudsmen complaint data from 2006 to 2011.

LTCCC authors Cynthia Rudder, Richard Mollot, and Lucia Caltagirone highlight examples of continued poor quality of care in assisted living facilities — including adult homes, enriched housing, assisted living residences, and the state’s Medicaid-funded assisted living programs (ALPs) — and recommend ways in which the state legislature and DOH could improve oversight and enforcement. All of these assisted living options are licensed under New York’s adult home regulations.

The LTCCC’s report was supported by a grant from the Robert Sterling Clark Foundation.

Significant Findings

The report concludes that more than two-thirds of adult homes and assisted living residences are violating the state’s care rules, and are either harming their residents or putting them at risk for harm. This conclusion is based on the following findings:

• Few violations cited led to enforcement actions unless they were “endangerment” violations.
• Approximately three-quarters of the facilities found to have endangered their residents have been sanctioned or fined. However, many of the cases have yet to receive a final disposition, including eight from more than three years ago.
• “Impacted homes” — a term that is applied to adult homes with 25 percent or more mentally disabled residents — have twice as many violations as the “non-impacted” homes.

Continued Non-Compliance

The three areas most cited by DOH have remained the same for nine years — resident care, medication, and environmental issues. In fact, almost one-quarter of the medications citations are repeats from previous years.

Some of the reasons listed for non-compliance include:

• The state recommends a training program for direct-care staff, but does not require residences to train their care staff with a mandated training curriculum;
• Administrators are not licensed as required; and
• Facilities are only required to give 3.75 hours of personal care per week to each resident. According to the authors, this is insufficient time for staff to care for residents on multiple medications.

Policy Implications

“This report makes a valuable contribution to understanding the provision and oversight of assisted living in New York — an area that is still relatively unknown,” said PHI New York State Policy Director Carol Rodat. “These findings should encourage policymakers to pursue better training across all care settings.”

As a result of their findings, the LTCCC authors recommend two important changes in enforcement policy:

• Revise the current state law which does not permit a fine if the facility corrects the violation, and
• Increase the number of DOH agency staff to facilitate effective and timely enforcement.

– by Meghan Shineman, PHI New York Policy Analyst

Sen. Bob Casey (D-PA)

On May 26, the U.S. Senate Special Committee on Aging, chaired by Senator Herb Kohl (D-WI), hosted a hearing on the pending reauthorization of the Older Americans Act of 1965 (OAA).

The law governs a nationwide network of agencies and programs to deliver social services to older adults to help them maintain independence in their homes and communities.

The hearing, entitled “Meals, Rides, and Caregivers: What Makes the Older Americans Act So Vital to America’s Seniors,” featured testimony by:

• Kathy Greenlee, assistant secretary, Administration on Aging (AoA); U.S. Department of Health and Human Services [testimony];
• Rosalynn Carter, former First Lady and president of the Rosalynn Carter Institute for Caregiving; and
• others, including an advocate, a service provider, a state long-term care ombudsman, and a beneficiary of OAA programs.

The witnesses addressed a wide range of topics, including:

• the needs of family caregivers;
• new programs to be administered by AoA (the CLASS program, the State Health Insurance Assistance Program, and the Senior Community Service Employment Program);
• increased responsibilities of long-term care ombudsmen; and
• options for administering OAA programs more efficiently.

Specialized Training Necessary

Senator Bob Casey (D-PA), a member of the Committee, asked Carter to comment on evidence-based programs for the specialized training necessary for caregivers –- especially direct-care workers.

Casey paid tribute to the commitment of direct-care workers, saying “I have been…overwhelmed by the kind of care that is delivered by direct-care workers — how strong they are, how dedicated they are — willing to do back-breaking and sometimes seemingly impossible work on behalf of those who need that care and on behalf of their families.”

Carter responded by sharing information about approaches the Institute is testing to provide training to family caregivers of individuals with Alzheimer’s Disease, referred to in their October 2010 report, “Averting the Caregiving Crisis: Why We Must Act Now.”

Supporting the Direct-Care Workforce

Responding to the same question from Senator Casey, Assistant Secretary Greenlee commented that it “will take many different federal organizations working together” in order to address how the U.S. will “support the public programs — the CLASS Act, Medicare and Medicaid programs, the programs we have under the OAA, disability programs — with a paid workforce and provide enough support to that workforce so that they have meaningful career ladders, but also so that they have the skill set to serve an increasingly aging population.”

The Leadership Council of Aging Organizations, of which PHI is a member, submitted recommendations (pdf) on the reauthorization of OAA, some of which will bolster the direct-care workforce.

– by Gail MacInnes, PHI National Policy Analyst

The SCAN Foundation has released the first two curricula in a series designed to enhance the skills of California’s direct-care workforce, including “Strengthening Communication and Problem Solving Competencies,” which was designed by PHI.

Each of the curricula in the series employs adult learner-centered methods of teaching to enhance the learning of participants and improve the quality of care provided by the state’s 150,000-plus certified nursing assistants (CNAs) and home health aides.

“Strengthening Communication and Problem Solving Competencies,” a six-hour in-service training, “focuses on active listening and problem-solving skills, which are the building blocks of culture change” in long-term care facilities, said Peggy Powell, PHI National Director of Curriculum and Workforce Development. The PHI training supports the Centers for Medicare and Medicaid Services‘ (CMS) guidelines to provide more resident-centered care.

The six hour-long modules are:

• Introduction to Resident-Centered Care and Active Listening
• Active Listening: Paraphrasing
• Active Listening: Asking Open-Ended Questions
• Managing Emotions: Pulling Back
• The Exploring-Options Approach to Problem-Solving
• Giving Constructive Feedback

“The SCAN Foundation’s efforts to fund the development and dissemination of these adult learner-centered training curricula have resulted in an important resource to enhance direct-care worker caregiving competence,” Powell said.

“Although tailored to the California direct-care workforce, our curriculum can be adapted for direct-care workers in any state,” she continued.

Other Trainings

The other curriculum that is currently available is “Care at the End of Life,” which prepares direct-care staff to help residents and their families cope with death and dying.

Each of the trainings in the series is interactive, outcome-based, and designed to be taught in an in-service setting in a relatively short period of time. “Care at the End of Life,” for example, comprises three modules, each lasting roughly 15-20 minutes.

The SCAN Foundation will release another four curricula in the series:

• Dementia: Understanding and Responding to Behaviors;
• Strengthening Communication and Building Partnerships with Family Caregivers;
• Managing Pain in Older Adults; and
• Pills and Spills (which focuses on medication administration and falls prevention).

The development of the trainings was funded by a series of grants awarded by The SCAN Foundation in 2009. In addition to PHI, grant recipients included Aging Services of California; San Diego Hospice and the Institute of Palliative Medicine; the University of Southern California’s Schools of Gerontology and Pharmacy; and the University of California, Irvine’s Program in Geriatrics.

– by Matthew Ozga