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The PHI Center for Coaching Supervision and Leadership (CCSL) produced numerous positive, tangible outcomes for employers, according to a just-released PHI evaluation summary of the program.

Participants in the CCSL, for example, reported improvements in quality of care as well as statistically significant gains in job satisfaction among all staff.

The four-year CCSL program was designed to refine the PHI Coaching Approach to Supervision, a training program that teaches long-term care supervisors the core communication skills necessary to effectively engage and support their teams.

Eleven providers in the Northeast U.S., including five nursing homes and six home health agencies, were involved in the CCSL initiative.

Specific Findings

PHI’s evaluation of the CCSL program found that:

• Trained supervisors retain the lessons of PHI Coaching Supervision^SM. One year after their training, more than three-fourths (77 percent) of supervisors involved in CCSL said they “often” or “always” used the communication skills they were taught.
• Job satisfaction increased. Direct-care workers surveyed showed significant improvements in job satisfaction following the CCSL intervention.
• Some employers experienced efficiencies. Three out of 10 supervisors and managers reported spending less time solving other people’s problems. All told, 25 supervisors reported a total of 75 hours saved per week, or nearly four weeks each year for each supervisor.
• Certain participants reported increased care quality. For example, one of the CCSL participants — Orchard Cove, a continuing care retirement community in Massachusetts — recorded downward trends in fall prevalence, urinary tract infections, pressure ulcers, and other quality indicators.
• Providers invested in sustainability. Evaluation respondents expressed their interest in sustaining the positive outcomes they gained from PHI Coaching Supervision training. To that end, they have instituted numerous strategies — including booster sessions and the use of cross-functional teams — intended to “keep coaching alive.”

CCSL was funded by the John A. Hartford Foundation and The Atlantic Philanthropies.

More information about the PHI Coaching Approach is available at the PHI Training & Organizational Development Services website.

More information about the evaluation of PHI initiatives and services is available at the PHI Evaluation page.

– by Matthew Ozga

Massachusetts State House in Boston

PHI Massachusetts lent its support to two bills at a July 19 hearing on home and community health care provider policies, held by the Joint Committee on Public Health.

“An Act Relating to Training for Certified Nurses’ Aides and Direct-Care Workers,” Senate Bill 1121, calls for a review of current training standards for home health aides and certified nurse aides (CNAs) in the state.

“An Act Relative to Home Health Aides,” Senate Bill 1138, would expand the current role of home health aides (HHAs) in the state and, with appropriate training and oversight, allow them to administer some medications.

Facilitating a Career Lattice

Passage of the training standards bill would be well-timed: Massachusetts is one of six states to receive a Personal and Home Care Aide State Training (PHCAST) demonstration grant from the Department of Health and Human Services.

“The PHCAST demonstration grant will position Massachusetts as a leader on training standards for personal care attendants and personal care aides nationally — and also lay the foundation for a portable credential in the state,” said PHI Massachusetts State Director Amy Robins in her hearing testimony.

“A close examination of training standards for CNAs and HHAs could help facilitate the creation of a clearly articulated and intentional career lattice among direct-care occupations. This would allow workers to advance to new positions and move across settings — keys to cultivating, recruiting, and retaining the direct-care workforce Massachusetts will need in the coming years,” Robins’ testimony (pdf) concluded.

Medication Administration

Senate Bill 1138 provides a very attainable advancement opportunity for HHAs who are interested in medication administration.

“The experience of others demonstrates that this can be done safely and effectively — and that this strategy also helps ensure the best value for our health care spending, with all working to the top of their training and licensing,” Robins’ testimony (pdf) said.

The bill “would send a clear signal that the state recognizes the importance of this vital workforce and the need to do more to improve these jobs and create meaningful advancement opportunities,” her testimony continued.

There are nearly 100,000 direct-care workers in Massachusetts. Direct-care jobs are the second largest occupational grouping in the state and are expected to grow by 22 percent by 2016, dramatically outpacing the growth of other jobs.

Home and community-based direct-care jobs are among the state’s lowest-paying jobs, paying wages that fall below the state’s low-wage threshold.

“Quite simply, the state must do more to cultivate a high-quality, well-trained and stable workforce,” Robins says. “These two bills are important steps in the right direction.”

For more information on the direct-care workforce in Massachusetts, see State Facts: Massachusetts’ Direct-Care Workforce (pdf).

– by the PHI Policy team

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