Category Archives: Nursing Homes & Long Term Care

Nursing Home Workers Win Wage Gains with Credible Strike Threat

Source: Leah Fried, Labor Notes, May 26, 2017

After close to three years of negotiations, stickers and leaflets weren’t getting the boss any closer to a fair agreement. The master contract covering 10,000 nursing home workers in Illinois had been expired for two years and extended several times.

Management was insisting on a wage freeze until Illinois overcame its budget impasse and increased Medicaid reimbursements. Long-term workers were languishing at minimum wage, even when their employers had begun offering higher wages to entice new hires.

Meanwhile, staffing was dangerously short. Often a certified nursing assistant was forced to care for 20 or more residents in an eight-hour shift—bathing, feeding, and assisting them at a furious pace. On top of keeping the nursing home clean, a housekeeper had to collect meal trays for hundreds of residents because there weren’t enough dietary aides.

To win a new agreement, it was clear that workers would need to be prepared to strike.

But their local, Service Employees (SEIU) Healthcare Illinois-Indiana (HCII), hadn’t ever waged a strike over its master nursing home contract. In fact, the last time there was a nursing home strike at any of these facilities was in 1979. The local’s previous contract campaigns had been lackluster. Mobilization had been limited to stickers, petitions, and a practice picket.

And giving each nursing home the organizing attention it needed now was a huge challenge. The bargaining unit covers 28 different employers and 103 facilities statewide…..

Implementation of a resident handling programme and low back pain in elder care workers

Source: Andreas Holtermann, Occupational & Environmental Medicine, Volume 74, Issue 6, 2016
(subscription required)

From the introduction:
Low back pain (LBP) is the most important contributor to number of years lived with a disability and a major risk factor for sickness absence and work disability. Occupational groups with physically demanding work, like healthcare workers, have particularly high prevalence of LBP, and a considerable fraction of the LBP is considered to be caused by work-related factors. Moreover, LBP is a particular barrier for sustainable employment among workers with physically demanding work. Therefore, implementation of equipment (mechanical lifts or other assistive devices) for reducing the mechanical loading of healthcare workers during manual handling of residents should theoretically be efficient for preventing LBP and sickness absence among those with LBP. However, interventions implementing equipment for reducing the mechanical loading on healthcare workers during manual handling of residents show conflicting results on LBP. This might be due to the relatively short follow-up period of previous intervention studies introducing equipment for manual handling, which may need longer time before being fully implemented in an organisation. Moreover, it can be caused by lacking repetitive measures of both the implementation of the intervention as well as the often fluctuating level of LBP. Thus, there is a research gap in the documentation of the effects on LBP

The Impact of the Affordable Care Act on Health Coverage for Direct Care Worker

Source: Stephen Campbell, PHI, Issue Brief, March 2017

From the summary:
Direct care workers—nursing assistants, home health aides, and personal care aides who support older Americans and people with disabilities—are among America’s lowest paid workers, often struggling to access health coverage. However, new coverage numbers show that this workforce benefited substantially from the Affordable Care Act (ACA). Between 2010 and 2014, half a million direct care workers gained coverage. At the same time, the uninsured rate across this workforce decreased by 26 percent. As the Trump administration and the new Congress consider the future of the Affordable Care Act (ACA) and Medicaid, it is important to consider the impact of these changes on this critical U.S. workforce.

60 Caregiver Issues

Source: PHI, 2017

In 2017, PHI began identifying the most pressing policy issues facing direct care workers. Our research, unique industry expertise, and partnerships with state and national leaders aptly position us to address a worsening concern: direct care workers are walking away from this sector at a time when we need critical supports to age in our homes and communities. In turn, families and the agencies that serve them are left with few options.

Recognizing a growing workforce shortage among our nation’s home care aides, nursing aides, and personal care aides, as well as the need to provide quality care to a rapidly growing population of older people and people with disabilities, PHI launched a national campaign: 60 Caregiver Issues.

Over the course of two years, PHI will release a new issue every 2-3 weeks, inspiring policy makers and long-term care leaders to pinpoint what needs to be done to remedy this shortage and create a vibrant, sustainable system of long-term care.

The Family Time Squeeze: Perceived Family Time Adequacy Buffers Work Strain in Certified Nursing Assistants With Multiple Caregiving Roles

Source: Nicole DePasquale, Jacqueline Mogle, Steven H. Zarit, Cassandra Okechukwu, Ellen Ernst Kossek, and David M. Almeida, The Gerontologist, Advance Access, First published online: January 10, 2017
(subscription required)

From the abstract:
Purpose of the Study: This study examined how certified nursing assistants (CNAs) with unpaid family caregiving roles for children (“double-duty-child caregivers”), older adults (“double-duty-elder caregivers”), and both children and older adults (“triple-duty caregivers”) differed from their nonfamily caregiving counterparts (“workplace-only caregivers”) on four work strain indicators (emotional exhaustion, job satisfaction, turnover intentions, and work climate for family sacrifices). The moderating effects of perceived family time adequacy were also evaluated.

Design and Methods: Regression analyses were conducted on survey data from 972 CNAs working in U.S.-based nursing homes.

Results: Compared with workplace-only caregivers, double-and-triple-duty caregivers reported more emotional exhaustion and pressure to make family sacrifices for the sake of work. Triple-duty caregivers also reported less job satisfaction. Perceived family time adequacy buffered double-duty-child and triple-duty caregivers’ emotional exhaustion and turnover intentions, as well as reversed triple-duty caregivers’ negative perceptions of the work climate.

Implications: Perceived family time adequacy constitutes a salient psychological resource for double-duty-child and triple-duty caregivers’ family time squeezes. Amid an unprecedented demand for long-term care and severe direct-care workforce shortages, future research on workplace factors that increase double-and-triple-duty caregiving CNAs’ perceived family time adequacy is warranted to inform long-term care organizations’ development of targeted recruitment, retention, and engagement strategies.

Who Hires Social Workers? Structural and Contextual Determinants of Social Service Staffing in Nursing Homes

Source: Amy Restorick Roberts and John R. Bowblis, Health & Social Work, Advance Access, First published online: December 7, 2016
(subscription required)

From the abstract:
Although nurse staffing has been extensively studied within nursing homes (NHs), social services has received less attention. The study describes how social service departments are organized in NHs and examines the structural characteristics of NHs and other macro-focused contextual factors that explain differences in social service staffing patterns using longitudinal national data (Certification and Survey Provider Enhanced Reports, 2009–2012). NHs have three patterns of staffing for social services, using qualified social workers (QSWs); paraprofessional social service staff; and interprofessional teams, consisting of both QSWs and paraprofessionals. Although most NHs employ a QSW (89 percent), nearly half provide social services through interprofessional teams, and 11 percent rely exclusively on paraprofessionals. Along with state and federal regulations that depend on facility size, other contextual and structural factors within NHs also influence staffing. NHs most likely to hire QSWs are large facilities in urban areas within a health care complex, owned by nonprofit organizations, with more payer mixes associated with more profitable reimbursement. QSWs are least likely to be hired in small facilities in rural areas. The influence of policy in supporting the professionalization of social service staff and the need for QSWs with expertise in gerontology, especially in rural NHs, are discussed.

County Benchmarking Engine

Source: OnlyBoth, 2016

Benchmark a U.S. county or county-equivalent against all 3,143 counties described by 104 attributes.

There are 170,250 insights, or about 54 per county.

County data relates to geography, population, education, housing, income, employment, healthcare, resources, religion, land, and arrests.

Data sources are USDA ERC, CDC, HUD, CMS, DHSS, DOJ FBI, and USGS (all federal) plus the Association of Religion Data Archives (thearda.com).
Related:
Benchmark a hospital
Benchmark a nursing home
Benchmark a [private] college’s finances

Long-Term Care Workforce: Better Information Needed on Nursing Assistants, Home Health Aides, and Other Direct Care Workers

Source: U.S. Government Accountability Office (GAO), GAO-16-718, August 16, 2016

From the summary:
Federal data sources provide a broad picture of direct care workers—nursing assistants and home health, psychiatric, and personal care aides—who provide long-term services and supports (LTSS), but limitations and gaps affect the data’s usefulness for workforce planning. Some states have collected data in areas where federal data are limited, but these have been one-time studies. Federal data show that direct care workers who provide LTSS numbered an estimated 3.27 million in 2014, or 20.8 percent of the nation’s health workforce. Federal data show that wages for direct care workers, while differing by occupation, are generally low, averaging between approximately $10 and $13 per hour in 2015. However it is unclear to what extent these wage data include direct care workers employed directly by the individuals for whom they care. The number of these workers, often referred to as independent providers, is believed to be significant and growing. Some states, in coordination with the federal government or on their own, have conducted studies about direct care workers and collected detailed information. These studies showed that a majority of independent providers worked for a family member or someone else they knew.

Caregiving Crisis Highlighted in PHI Fact Sheets

Source: Paraprofessional Healthcare Institute (PHI), September 6, 2016

From the blog post:
Two fact sheets from PHI highlight the low wages, high injury rates, and high demand that characterize nursing assistant and home care aide jobs, two occupations at the center of the U.S. caregiving crisis: – U.S. Home Care Workers: Key Facts
U.S. Nursing Assistants Employed in Nursing Homes

Key Facts Among the findings:
– 633,000 additional home care workers are needed by 2024, more new jobs than any other occupation in the U.S. economy.
– Low wages, limited work hours, and low annual earnings cause one in four home care workers to live in poverty, compared to one in ten U.S. workers.
– This high poverty rate means one in two home care workers relies on some form of public assistance, such as food stamps, Medicaid, or cash assistance.
– Nursing assistants are more than three times as likely to be injured on the job than the average U.S. worker.
– Due primarily to poor job quality, 52 percent of nursing assistants leave their jobs each year, and 50,000 nursing assistant positions nationwide cannot be filled.
The fact sheets, which provide comprehensive analyses on workforce demographics, size and composition, job quality indicators, and employment projections, will be released on an annual basis.