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Washington State will need an additional 440,000 home care workers between now and 2030 to meet the rising demand for home care, according to a report on worker turnover published by SEIU Healthcare 775NW.

The SEIU’s projection assumes an annual turnover rate of 35 percent. Currently, home care worker turnover in Washington averages around 50 percent a year, the report states.

The report argues that turnover is so high because of:

• home care workers’ frustration with low wages;
• inconsistent, part-time hours;
• inadequate benefits; and
• a lack of career opportunities.

The authors of the report therefore recommend several steps to boost retention among home care workers in Washington, including:

• raising hourly wages to at least $17.58;
• developing strategies to ensure that workers have stable hours;
• improving the health insurance and retirement benefits available to workers;
• expanding the pool of home care workers who are eligible for such benefits; and
• creating career advancement opportunities.

State Budget Woes Linger

Implementing such steps, however, seems unlikely given the state’s current $2 billion budget shortfall, reports the Columbian.

Washington officials cited the state’s budgetary problems when it cut home care services by eight hours a month for certain Medicaid recipients.

On February 21, twelve home care workers associated with SEIU were arrested after staging a sit-in protest against these cuts at the state Office of Administrative Hearings in Vancouver, Washington.

The cuts, which took effect February 1, were enacted by the state Department of Social and Health Services via an emergency ruling, allowing it to bypass the state legislature.

– by Matthew Ozga

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

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

Improving Job Quality: Direct Care Workers in the US — This paper presents several strategies for improving the quality of direct-care jobs in the U.S. and the U.K. It argues that a “decent public sector investment” in caregivers’ wages, working conditions, career advancement opportunities, and training requirements is necessary to substantially improve job quality. The paper was published in September 2011 by the Center for Economic and Policy Research.

Nursing Home Survey on Patient Safety Culture: 2011 User Comparative Database Report — This August 2011 survey contains data compiled from 226 nursing homes throughout the U.S. The data presents the opinions of nursing home staff regarding resident safety, the incidence of medical errors, and event reporting. The survey was conducted by the federal Agency for Healthcare Research and Quality.

Cost of Turnover in the Direct Care Workforce — This June 2011 report by the Iowa Department of Public Health estimates that statewide turnover among the direct-care workforce cost Iowa $117 million in 2010 alone. That figure is expected to increase as the workforce grows larger; by 2015, turnover will cost $148 million.

The Influence of Nurse Staffing Levels on Quality of Care in Nursing Homes — This study examines the relationship between the certified nursing assistant (CNA) staffing levels and the Nursing Home Compare scores of Florida nursing homes. The authors demonstrate a correlation: For every six-minute increase in CNA hours per resident day, a nursing home sees a 3 percent reduction in its care-quality deficiency score. The authors therefore conclude that nursing home providers would benefit by hiring more CNA staff. The study was published on the website of the Gerontologist in May 2011.

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

A new study published in the Journal of Disability Policy Studies examines the consequences of high worker turnover on the cost of long-term care and whether government wage subsidies to reduce turnover would be cost-effective.

Researchers Elizabeth Powers and Nicolas Powers report their findings on worker turnover at Illinois’ Community Integrated Living Arrangements (CILAs), community-based group residential services for people with developmental disabilities, in “Should Government Subsidize Caregiver Wages? Some Evidence on Worker Turnover and the Cost of Long-Term Care in Group Homes for Persons with Developmental Disabilities.”

The study found that higher worker turnover increased:

• state-reimbursed training costs;
• the number of workers engaged in training; and
• the cost of workers’ compensation to the agencies.

The agencies studied by the researchers tolerate high levels of turnover, but one of the obvious costs of this turnover — the training of new employees — is not directly borne by the agencies. Rather, the training is paid for by the state through Medicaid reimbursements paid to agencies. That is, agencies can shift this cost of turnover to the state, and as a result don’t “internalize” it.

The authors note that their findings support a statement by PHI Director of Policy Research Dorie Seavey in a 2004 report on frontline turnover in long-term care that says “providers may not find it cost-effective to make the investments needed to reduce turnover” when they don’t directly bear the full costs of turnover.

However, the authors also conclude that, although state-subsidized entry-level training “implicitly encourages worker turnover,” eliminating the subsidies is undesirable because it would result in undertrained workers which would pose a risk to consumers — a risk that “outweighs the concern of encouraging worker turnover by subsidizing training.”

Benefits of Wage Subsidies

Instead, the authors recommend a wage subsidy for the workforce in order to reduce turnover. In other published work by the authors, they estimated that increasing annual compensation for workers in the range of 24 to 31 percent (at an annual cost of $4,820 to $6,144 per full-time equivalent direct service provider) would have cut the turnover rate by one-third.

Based on the agencies sampled in the current study, the authors estimate that a reduction in turnover of this magnitude could be achieved by a 9-12 percent increase in the state’s reimbursement rate (which includes food, shelter, and supervision).

The authors note that the cost of reducing worker turnover through a wage increase is relatively modest in comparison to the state’s per diem rate for CILA and would bring benefits to four parties:

• workers (through increased compensation);
• consumers (through improvements in the quality of care);
• agencies (through productivity gains and nonreimbursable cost reductions); and
• the state (through reductions in state-reimbursable costs).

The authors conclude that “there is a compelling case for government policies that subsidize frontline worker wages for the purpose of reducing worker turnover, even without consideration of worker welfare.”

– by Deane Beebe

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

PHI joined more than 300 ombudsmen, long-term care consumers, nursing home family and resident council members, professionals, government officials, nursing home employees’ union representatives, and advocates this week at the Consumer Voice‘s 35th Annual Meeting and Conference, which kicked off in Orlando, Florida, on October 18.

PHI was one of the sponsors of this year’s conference, and helped several direct-care workers attend the event.

Person-Centered Care and Culture Change the Buzz

Many of this year’s conference sessions have focused on — or included discussion of — strategies to achieve culture change and deliver person-centered care. The role of the direct-care workforce in achieving culture change was highlighted throughout these workshops.

PHI, which is currently partnering with SAGE on the National Technical Assistance Resource Center for LGBT Elders, was pleased to see a workshop addressing the challenges of supporting LGBT elders.

At “Gay and Gray or Heading That Way,” presenter Debi Lee, lead regional ombudsman, Centralina [North Carolina] Area Agency on Aging, discussed her organization’s project on bridging the gap between direct-care workers and lesbian, gay, bisexual, and transgender (LGBT) elders through relationship building, training, mutual support, and advocacy.

Lee noted that, in order for the project’s second phase to be more successful at bridging that gap, its events will take place in nursing facilities and while direct-care workers are on the clock, rather than on their own unpaid time.

Models for Quality Improvement

At “Innovative Collaborations to Improve Nursing Home Life for Residents, Family, and Staff,” two innovative models were presented.

Direct-care workers from Virginia’s Trinity Mission Health and Rehabilitation (pictured below) discussed how their facility used Civil Monetary Penalty funding for its quality improvement project to reduce certified nursing assistant turnover by 25 percent. To achieve their goal the facility works to:

• empower CNAs
• provide CNAs with more support
• enhance CNA awards and recognition opportunities
• enhance CNA skills and training
• create a CNA mentorship program for new staff
• involve CNAs in care plan meetings

“The CNAs are key members of the team; they know and work closely with the residents,” said Claire Curry, legal director of the Virginia-based Legal Aid Justice Center, which initiated the Community Partnership for Improved Long-Term Care, Trinity Mission’s project partner.

Presenters (L-R): Sheila Faulkner, Brittany Burgess, Melva Proctor, Latisha Ayres, Phyllis Crenshaw, and Zelda McGruder

“It is preposterous when the CNAs are not a part of the care planning meetings…. [Their input] is essential to delivering person-centered care,” Curry said.

During this session, Karlin Mbah, family council coordinator and policy advocate for FRIA: The Voice and Resource for Quality Long-Term Care, discussed a project the organization is launching in 2011 with family councils and the 1199 SEIU Labor Management Project.

In this collaboration, family caregivers and direct-care workers are strengthening their relationships by looking at the meaning of the word “dignity” as it applies to workers, family members, and residents.

“Family and friend caregivers believe that working together from the bottom-up — formal and informal caregivers — can bring person-centered care to nursing homes,” Mbah said.

OAA Reauthorization Act and the Direct-Care Workforce

PHI National Policy Analyst Gail MacIness was a panelist for the plenary session entitled “Older Americans Reauthorization Act — Listening Session,” where she discussed PHI’s recommendations (pdf) on:

• improving training and empowerment for the direct-care workforce;
• building infrastructure for self-directed services; and
• incorporating workforce planning and assessment into the aging services network.

Official listeners from the U.S. Senate Special Committee on Aging and the Administration on Aging participated in the panel presentation.

Preventing Elder Abuse

A presentation on stopping elder abuse included information on how professionals can help.

During the Q and A, PHI staff had the opportunity to highlight the role of direct-care workers in preventing abuse, as well as PHI’s free curriculum, Adult Abuse & Neglect Prevention Training.

– by Deane Beebe