Category Archives: Nursing Homes & Long Term Care

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.

The Structural Burden of Caregiving: Shared Challenges in the United States and Canada

Source: Miles G. Taylor and Amélie Quesnel-Vallée, The Gerontologist, Advance Access, First published online: August 12, 2016
(subscription required)

From the abstract:
In contrasting health care structures, we each served as caregivers to elderly parents where a shared and unexpected theme in our experiences was the substantial burden of negotiating and managing long-term care (LTC) services within our respective health and social care systems. In this article, we introduce and elucidate an under recognized source of caregiver burden in the United States and Canada: the structural burden of caregiving. We draw on shared and unique experiences cross-nationally, along with the literature, to illustrate that (a) today’s caregiving is increasingly characterized by interactions with formal health and social systems in negotiating and managing services, (b) these systems are hampered by discontinuous and fragmented care which increase caregiver stress, and (c) this structural burden likely exacerbates inequity for both care recipients and caregivers. In conclusion, we call for theoretical models of caregiving to highlight health and social systems as creating burden and for measurement of caregiver burden to explicitly consider the time and stress stemming from interactions with formal health and social systems. Finally, we call for future policy evaluation to incorporate structural burden as an additional outcome in considering changes to LTC provisions and funding.

Development and Validation of A Scheduled Shifts Staffing (ASSiST) Measure of Unit-Level Staffing in Nursing Homes

Source: Greta G. Cummings, Malcolm Doupe, Liane Ginsburg, Margaret J. McGregor, Peter G. Norton and Carole A. Estabrooks, The Gerontologist, Advance Access, First published online: February 16, 2016
(subscription required)

From the abstract:
Purpose of the study: To (a) describe A Scheduled Shifts Staffing measure (ASSiST) to derive care aide worked hours per resident day (HCA WHRD) at facility and unit levels in nursing homes, (b) report reliability through comparisons to administrative staffing data; (c) report validity by examining associations between HCA WHRD, staff outcomes (job satisfaction, emotional exhaustion), and resident quality indicators (QIs) (e.g. falls, delirium, stage 2+ pressure ulcers), and (d) explore intrafacility variation in staffing intensity levels related to unit-level variation in resident and staff outcomes.
Design and Methods: We used data from 40 care units in 12 Canadian nursing homes between 2007 and 2012. Descriptive statistics and tests of association and difference described relationships of two measures of staffing with resident and staff outcomes.

Results: Annualized rates of HCA WHRD from both data sources compared well at the facility level, and were correlated similarly to staff work life and many QIs. Using ASSiST data, we show that staffing levels can vary by up to 40% at the unit-level within nursing homes.

Implications: ASSiST is easy to collect, more timely to retrieve than administrative data, has good criterion and construct validity, and reflects intrafacility variation in health care aide staffing levels.

CNA Training Requirements and Resident Care Outcomes in Nursing Hom

Source: Alison M. Trinkoff, Carla L. Storr, Nancy B. Lerner, Bo Kyum Yang and Kihye Han, The Gerontologist, Advance Access, First published online: April 8, 2016

From the abstract:
Purpose of the Study: To examine the relationship between certified nursing assistant (CNA) training requirements and resident outcomes in U.S. nursing homes (NHs). The number and type of training hours vary by state since many U.S. states have chosen to require additional hours over the federal minimums, presumably to keep pace with the increasing complexity of care. Yet little is known about the impact of the type and amount of training CNAs are required to have on resident outcomes.

Design and Methods: Compiled data on 2010 state regulatory requirements for CNA training (clinical, total initial training, in-service, ratio of clinical to didactic hours) were linked to 2010 resident outcomes data from 15,508 NHs. Outcomes included the following NH Compare Quality Indicators (QIs) (Minimum Data Set 3.0): pain, antipsychotic use, falls with injury, depression, weight loss and pressure ulcers. Facility-level QIs were regressed on training indicators using generalized linear models with the Huber-White correction, to account for clustering of NHs within states. Models were stratified by facility size and adjusted for case-mix, ownership status, percentage of Medicaid-certified beds and urban-rural status.

Results: A higher ratio of clinical to didactic hours was related to better resident outcomes. NHs in states requiring clinical training hours above federal minimums (i.e., >16hr) had significantly lower odds of adverse outcomes, particularly pain falls with injury, and depression. Total and in-service training hours also were related to outcomes.

Implications: Additional training providing clinical experiences may aid in identifying residents at risk. This study provides empirical evidence supporting the importance of increased requirements for CNA training to improve quality of care.

Underpaid, unpaid, unseen, unheard and unhappy? Care work in the context of constraint

Source: Donna Baines, Sara Charlesworth, Tamara Daly, Journal of Industrial Relations (JIR), Vol. 58 no. 4, September 2016
(subscription required)

From the abstract:
Care work – in its paid and unpaid forms – spans the private, public and non-profit sectors in addition to being an essential underpinning of home and community life (Duffy et al., 2015). Due to its close association with gendered expectations of elastic, uncomplaining work undertaken by women across the continuum of home, community and residential places, care work continues to be undervalued in numerous ways (Baines, 2004; England, 2005; Folbre, 2008). Indeed, care workers often work in conditions in which they are underpaid, unpaid, unseen, unheard and unhappy (Daly and Szebehely, 2012; Palmer and Eveline, 2012). These conditions are related to government austerity models; how care work is regulated within employment relations; state, market and private roles providing and funding care; and how care work organisation is shifting in the context of austerity strategies, policies of constraint, continued high demand, decreased union density and increasing standardisation.

These conditions and the women who work within them and around them are the focus of this Special Issue: Care Work in the Context of Constraint. The Special Issue draws together international researchers and scholars in a close investigation of the complexity of care work in the era of austerity policies.
Government bodies that fund care work have been under increasing pressure to cut costs, expand accountability and contribute to austerity agendas (Brennan et al., 2012; Cunningham et al., 2014; Grimshaw and Rubery, 2012). This impacts at the level of care organisations in the form of decreased financial resources and increased obligations to provide documentary and statistical evidence of the care provided to service users…..